风湿性心脏瓣膜置换术1 061例临床分析

目的:对1061例风湿性心脏病瓣膜置换术进行早期疗效观察及临床分析。方法:对2000年1月～2005年12月入院施行瓣膜置换术的风湿性心脏瓣膜病例进行回顾总结。结果:1061例中,术后早期病死率1.32%(14例),主要死亡原因为低心排血量综合征(3例)和心室颤动(3例)。术后早期并发症发生率6.41%(68例),其中低心排血量综合征13例、严重心律失常12例,两者占36.76%。结论:术前改善心功能、术中加强心肌保护和改进手术方法、积极处理术后并发症是提高风湿性心脏病瓣膜置换术疗效的重要措施。     

部分心包剥脱术治疗慢性缩窄性心包炎疗效观察

目的观察部分心包剥脱术治疗慢性缩窄性心包炎的疗效,并总结手术经验。方法在全身麻醉下行部分心包剥脱术治疗慢性缩窄性心包炎89例,其中6例在体外循环辅助下手术。结果围术期死亡2例,死因为术后低心排血综合征1例,术中右心房破裂出血修补失败1例。均获随访,心功能恢复到Ⅰ级者80例,Ⅱ级者9例。结论心包剥脱术是治疗慢性缩窄性心包炎的有效方法。体外循环辅助是预防术中严重并发症的有效手段。     

高原地区慢性缩窄性心包炎的外科治疗

目的:总结分析高原地区慢性缩窄性心包炎的手术治疗及围手术期处理经验。方法:回顾性分析76例慢性缩窄性心包炎患者的临床资料,全部患者均在全身麻醉下取胸骨正中切口行部分心包剥脱术。结果:术后死亡3例,2例死于术后低心排综合征,1例死于呼吸功能衰竭。术后出现并发症17例,6例术后因引流多而行二次开胸止血术。术后患者住院时间(15.3±6.4)d,症状改善明显。病理确诊为结核性心包炎49(64.4%)例。结论:注重高原地区慢性缩窄性心包炎的特殊病理生理改变,早期诊断、及时手术、充分合理的心包剥脱范围,正确的围术期处理是手术成功和提高远期疗效的关键。     

心脏瓣膜置换术后早期死亡原因及相关因素分析

目的:探讨心脏瓣膜置换患者术后早期死亡原因及相关危险因素。方法:回顾性总结我院胸心血管外科自2009-06-2012-06行心脏瓣膜置换的425例患者的临床资料,分析术后早期死亡原因及危险因素。结果:术后早期病死率3.52%,生存410例,死亡15例;单因素及多因素Logisitic回归分析提示:低心排综合征(LCOS),多器官功能衰竭(MOF),左室破裂,心功能Ⅳ级,LVEDD≥70mm及CPB转流时间≥180min是影响瓣膜置换患者术后早期死亡的重要危险因素(P0.05)。结论:LCOS、MOF及左室破裂是心脏瓣膜置换患者术后早期导致死亡的主要并发症。心功能Ⅳ级,LVEDD≥70mm及CPB转流时间≥180min可能是心脏瓣膜置换患者术后早期死亡的独立危险因素。     

心包剥脱术治疗缩窄性心包炎患者的近期疗效分析——单中心结果

目的总结127例缩窄性心包炎外科患者的手术治疗经验及疗效,为缩窄性心包炎手术时机及治疗方法提供依据。方法收集2015年3月至2019年3月成都市第三人民医院完成心包剥脱术的患者127例,根据患者发病到术前的病程分为5组:3个月以内组,3～6个月组,6～12个月组,1～3年组,3年以上组;统计各组患者的人数比例、症状、体征、手术时间、术后并发生症发生率及预后,手术后医生满意度等指标,对缩窄性心包炎外科手术效果作一简单评价。结果 127例均顺利完成手术,围术期死亡3例(2.36%)。随着病程时间的延长,患者术前症状及体征阳性率及严重程度增加;术后肺部并发症、低心排血量发生率有明显增加,尤其当病程超过3年后,低心排血量发生率较其他组有明显增加,住院时间明显延长。3～6个月病程组外科手术操作性差,心包组织残留率高,外科医生手术满意度最差。结论胸骨正中切口是心包剥脱术的最佳切口选择;术前针对性的强心治疗、营养支持、容量控制可减少术后并发症发生率;3～6个月病程组外科手术操作性差,外科医生手术满意度最差,心包组织残留率高,在病情稳定的情况下可酌情推后手术时间;心包剥脱范围应广泛,尽量做到不残留再狭窄的组织基础,外科医生的技术和策略对患者围术期生存率及远期效果有很大影响。     

缩窄性心包炎的外科治疗110例报告

目的探讨缩窄性心包炎外科治疗体会。方法回顾分析110例缩窄性心包炎临床资料及相关文献。结果本组采用优点较多的左外侧切口并横断胸骨经路。心包切除后获得良好效果。本组术后死亡率为3%,术后早期死亡原因为低心排,复发2例,误诊2例。结论手术为本症最佳治疗方法,术后早期出现黄疸是血液循环改善的指标之一。     

儿童机械瓣膜置换术121例的疗效

目的探讨儿童机械瓣膜置换术的疗效。方法14岁以下病童施行心脏机械瓣膜置换术121例,先天性心瓣膜病89例,风湿性心瓣膜病29例,心内膜炎24例(其中21例为先天性或风湿性心脏病患儿)。行二尖瓣置换62例,主动脉瓣置换49例,三尖瓣置换6例,双瓣置换4例。共置换机械瓣膜125枚。术后患儿均接受华法林抗凝。术后随访通过问卷或门诊检查完成。结果住院死亡15例,病死率12．4％(15／121);失随访32例。74例平均随访时间10．5年,晚期死亡1例,再手术2例。大部分存活病人心功能(纽约心脏协会分级)Ⅰ级-Ⅱ级。结论大多数儿童可以植入较大规格的机械瓣膜,保证远期生长发育需要。儿童机械瓣膜置换住院病死率高,合理的抗凝治疗可能提高远期疗效。     

80例心脏瓣膜置换术后常见并发症的预防和监护

风湿性心脏瓣膜病变是我国常见心脏病之一,大多数患者需经瓣膜置换手术治疗。瓣膜置换术对机体创伤大,加上体外循环,低温麻醉常导致病人生理功能发生紊乱,术后常可并发低心排综合症、出血、心律失常、血栓形成、感染等而危及生命。因此,做好术后监护工作,细心观察病情,精心护理是预防并发症发生的重要措施。现将我院从88年5月至95年12月共手术95例患者术后常见并发症预防和监护体会如下:     

儿童缩窄性心包炎10例手术治疗及远期随访

目的探讨儿童缩窄性心包炎的临床特征、手术治疗及随访结果。方法对广州市妇女儿童医疗中心2003年1月至2015年12月诊断为缩窄性心包炎的患儿的临床资料、手术治疗及随访结果进行回顾性分析。结果共收治行手术治疗的缩窄性心包炎患儿共10例,均为男性患儿,年龄3～14岁,体质量为21.4(12.5～36)kg,病程为1～36个月。术前心功能分级(NYHA)Ⅱ级7例,Ⅲ级3例。临床症状主要有腹胀(8例)、浮肿(6例)、气促(5例)、腹痛(3例)等;超声心动图提示为缩窄性心包炎9例,双心房扩大8例,腔静脉扩张5例,心包膜增厚4例,心脏计算机断层扫描(CT)检查诊断为缩窄性心包炎10例,心包增厚10例,心包钙化4例。手术方式均为心包剥脱术,术后恢复顺利,术后心功能分级I级6例,Ⅱ级3例,Ⅲ级1例。患儿术前、术后的心功能比较,差异有统计学意义(P=0.01)。术后随访2～14年,复发1例(10%);无死亡患者。结论儿童缩窄性心包炎临床症状不典型,心脏计算机断层扫描诊断符合率高,心包剥脱术是目前主要治疗手段,对于疑诊患者,心包开窗术可作为一种过渡性治疗。     

缩窄性心包炎外科治疗84例临床分析

目的 探讨手术治疗缩窄性心包炎的经验.方法 回顾分析近7年来84例缩窄性心包炎患者的外科治疗.结果 围术期死亡2例(2.78%),死于术后低心排量综合征.术后出现并发症11例.随访3个月至7年69例(82.1%),死亡1例,复发2例,余患者术后心功能恢复至Ⅰ～Ⅱ级.结论 手术治疗缩窄性心包炎是最有效的手段,掌握好手术时机、方法及注意围手术期处理是疗效的关键.     

Cardiac disease late after chest radiotherapy for Hodgkin's disease: a case report.

This report presents a case of occult constrictive pericarditis and mitral valve insufficiency following chest radiotherapy. A 44-year-old man had received radiotherapy for the treatment of Hodgkin's disease 8 years ago. At age 40 years, effusive pericarditis occurred and he was treated with intrapericardial drainage. Biopsy revealed a fibrotic and thickened pericardium. He developed congestive heart failure 3 years later. The patient was found to have occult constrictive pericarditis and mitral valve insufficiency. He underwent mitral valve replacement, tricuspid annul plasty, and pericardiectomy. Although there is the benefit of cure for the Hodgkin's disease, the prognosis after treatment is affected by radiotherapy-induced heart disease. After radiotherapy of the chest and mediastinum, long-term cardiological follow-up is recommended in order to detecting patients with radiation-induced heart disease, such as the present case.     

Constrictive pericarditis as a complication of coronary artery bypass surgery.

Although it is now recognised as a rare complication of cardiac surgery, constrictive pericarditis was diagnosed in three patients after coronary artery bypass surgery. The time interval between cardiac surgery and the development of constrictive features varied from two to six weeks. All three patients presented with severe congestive heart failure. Haemodynamic findings were characteristic of constrictive pericarditis. Pericardial thickening detected by computed tomography in one patient was useful in establishing a definite diagnosis. One of the patients had a serous constrictive effusive pericarditis, and surgical pericardial drainage was needed. The other patient underwent pericardiectomy with preservation of the grafts. The diagnosis of constrictive pericarditis should be considered in patients presenting with unexplained right sided heart failure after cardiac surgery.     

Constrictive pericarditis as a complication of coronary artery bypass surgery

Although it is now recognised as a rare complication of cardiac surgery, constrictive pericarditis was diagnosed in three patients after coronary artery bypass surgery. The time interval between cardiac surgery and the development of constrictive features varied from two to six weeks. All three patients presented with severe congestive heart failure. Haemodynamic findings were characteristic of constrictive pericarditis. Pericardial thickening detected by computed tomography in one patient was useful in establishing a definite diagnosis. One of the patients had a serous constrictive effusive pericarditis, and surgical pericardial drainage was needed. The other patient underwent pericardiectomy with preservation of the grafts. The diagnosis of constrictive pericarditis should be considered in patients presenting with unexplained right sided heart failure after cardiac surgery.     

Postoperative constrictive pericarditis

Seven cases of postoperative constrictive pericarditis (PCP) were discovered in a retrospective study of patients given heart surgery in a hospital receiving patients from all over Italy in 1970-85. Five of those patients had received surgery for chronic rheumatic heart disease, 2 for congenital heart defects. Four had received a second heart operation before the pericardial condition was recognised. All were females and all presented systemic venous hypertension (one of them only after acute doses of physiological solution) with thickening of the pericardial layers revealed by sonography. In six cases the electrocardiographic ventricular complexes were normal or increased in amplitude and the heart/chest ratio was greater than 0.55. Pericardial knock was masked by natural or artificial atrioventricular valve opening noises in 6 cases. In one case only there were pericardial calcifications or signs of an earlier postpericardiotomy syndrome. The haemodynamic investigation revealed signs of ventricular diastolic constriction in 6 patients. Three patients died from complications of cardiac cirrhosis: 2 of them had previously received partial pericardiectomy. Another two, given the same operation, preserved a reasonable functional capacity 5 and 10 years after the pericardiectomy. One patient in NYHA functional class III has so far refused haemodynamic assessment (and surgical treatment) of the pericardial disease. Finally, the last patient complains only of attacks of heart palpitation caused by atrial flutter and controlled by antiarrhythmic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Wegener's granulomatosis and the heart.

Three cases of Wegener's granulomatosis with cardiac complications are described and the relevant published reports are reviewed. The first case of Wegener's granulomatosis was associated with aortic regurgitation and required aortic valve replacement. The second and third cases were associated with pericardial disease requiring pericardiectomy for constructive pericarditis in one case, and haemorrhagic pericarditis with pericardial effusion in the other. Aortic valve involvement in Wegener's granulomatosis is uncommon and valve replacement has been described on only one previous occasion. Pericardial involvement is relatively common pathologically, but pericardial surgery has been described in this condition only twice, once for tamponade and once for constrictive pericarditis after pericardiocentesis. Cardiac involvement is not uncommon in patients with Wegner's granulomatosis and may be clinically important. Diagnosis is aided by estimation of the anti-neutophil cytoplasmic antibody titre.     

Constrictive pericarditis as a complication of cardiac surgery: recognition of an entity

Among 5,207 adult patients who underwent cardiac surgery, postoperative constrictive pericarditis was recognized in 11 patients (0.2% incidence rate). Seven patients had coronary arterial bypass grafting and 4 had valve replacement; the pericardium was left open in all cases. The average interval between surgery and presentation of pericardial constriction was 82 days (range 14 to 186). M mode echocardiography revealed epicardial and pericardial thickening in 7 cases and variable degrees of posterior pericardial effusion in 5 cases. Cardiac catheterization demonstrated uniformity of diastolic pressures with a characteristic early diastolic dip and late plateau pattern. Two patients responded to medical therapy for chronic pericarditis. One patient had a limited parietal pericardiectomy followed by recurrent constrictive pericarditis that eventually stabilized with medical therapy. The other 8 patients required radical pericardiectomy. The pathophysiology of constriction after surgery is unclear. Its clinical expression involves a wide spectrum of presentation and therapeutic response. Constrictive pericarditis may be a complication of cardiac surgery in spite of an open pericardium and should be considered in postoperative patients who present with deteriorating cardiac function.     

Surgical management of idiopathic constrictive pericarditis

Constrictive pericarditis is defined as impaired diastolic cardiac function leading to heart failure, progressive fluid overload, systemic venous congestion and reduction of cardiac output. Both ventricles affected by the constriction; however, symptoms of right heart failure dominate. The congestive heart failure and normal left ventricular systolic functions are seen in the presence constrictive pericarditis. Pericardiectomy is considered as the mainstay treatment method for constrictive pericarditis. Here we present successful pericardiectomy of a 68 year old female.     

左心瓣膜置换术后远期三尖瓣关闭不全的外科治疗

目的:评价左心瓣膜置换术后三尖瓣重度关闭不全外科治疗效果。方法:对25例左心瓣膜置换术后,人工瓣膜功能正常,三尖瓣重度关闭不全患者行三尖瓣成形术或三尖瓣置换术;首次手术二尖瓣置换术17例,二尖瓣加主动脉瓣置换术8例,在首次手术中10例曾行三尖瓣DeVega法成形术。结果:三尖瓣成形术13例;三尖瓣置换术12例。术后早期死亡4例,病死率16%。随访7个月～8年,平均(5.1±2.6)年,2例三尖瓣置换患者死于心血管事件,长期生存15例,心功能Ⅱ级8例,Ⅲ级4例,Ⅳ级3例,多数仍需强心、利尿药维持,临床症状明显改善。结论:对左心瓣膜置换术后三尖瓣重度关闭不全患者外科手术是一种合适的选择。合理掌握手术指征、手术时机和良好的围手术期治疗是手术成功的关键。     

Presentation pattern and management of effusive-constrictive pericarditis in Ibadan

Background: Effusive-constrictive pericarditis is a syndrome in which constriction by the visceral pericardium occurs in the presence of a dense effusion in a free pericardial space. Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging. We sought to provide further information by addressing the evolution and clinico-pathological pattern, and optimal surgical management of this disease. Methods: We conducted a prospective review of a consecutive series of five patients managed in the cardiothoracic surgery unit of University College Hospital, Ibadan, in the previous year, along with a general overview of other cases managed over a seven-year period. This was followed by an extensive literature review with a special focus on Africa. Results: The diagnosis of effusive-constrictive pericarditis was established on the basis of clinical findings of features of pericardial disease with evidence of pericardial effusion, and echocardiographic finding of constrictive physiology with or without radiological evidence of pericardial calcification. A review of our surgical records over the previous seven years revealed a prevalence of 13% among patients with pericardial disease of any type (11/86), 22% of patients presenting with effusive pericardial disease (11/50) and 35% who had had pericardiectomy for constrictive pericarditis (11/31). All five cases in this series were confirmed by a clinical scenario of non-resolving cardiac impairment despite adequate open pericardial drainage. They all improved following pericardiectomy. Conclusion: Effusive-constrictive pericarditis as a subset of pericardial disease deserves closer study and individualisation of treatment. Evaluating patients suspected of having the disease affords clinicians the opportunity to integrate clinical features and non-invasive investigations with or without findings at pericardiostomy, to derive a management plan tailored to each patient. The limited number of patients in this series called for caution in generalisation. Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.