二尖瓣替换术后9例左室破裂

二尖瓣替换术后左室破裂属少见而死亡率极高的并发症。阜外医院自１９７６年５月至１９９１年１０月行二尖瓣替换（ＭＶＲ）或合并其它手术共２０７５例，其中左室破裂９例，发生率为０．４３％（９／２０７５）；抢救成功３例。预防措施包括：（１）避免心脏受到各种机械性损伤；（２）保留左室生理结构环的完整性；（３）术中、术后早期心肌保护措施得当。     

保留二尖瓣装置的二尖瓣替换术40例临床体会

我院自１９９３年１０月至１９９６年８月施行保留二尖瓣装置的二尖瓣替换术（ＭＶＲ）４０例,效果良好,报告如下。临床资料本组４０例中男１６例,女２４例;年龄１５～５２岁。风湿性心脏病３６例,其中二尖瓣狭窄（ＭＳ）８例,ＭＳ并二尖瓣关闭不全（ＭＩ）１２例,...     

应用侧倾碟瓣单瓣替换90例

应用侧倾碟瓣单瓣替换９０例陈锁成，孙斌，王康荣，钱成，丁国文１９８１年２月至１９９３年１２月，我们应用侧倾碟瓣行心脏单瓣替换术９０例。其中二尖瓣替换术（ＭＶＲ）８４例，主动脉瓣替换术（ＡＷＲ）６例。现就治疗体会报告如下：资料与方法本组男３２例，女５８...     

人工机械瓣栓塞3例报告

人工机械瓣栓塞３例报告谢邦富沈回春姜子非彭华利李远平刘俊成１临床资料例１，女，３４岁，于１９９０年６月因风心病二尖瓣双病变、房颤、左房大（６１ｍｍ），在我院行二尖瓣替换（ＭＶＲ），置入２７号碟瓣。手术经过顺利，术后两周为逃避交费，未经医生同意和交待术...     

心脏人工瓣膜替换术510例

１９８７年６月至１９９７年１２月,我们共为５１０例病人施行了心脏人工瓣膜替换术。现就术前准备、手术方法以及术后处理等进行讨论如下。临床资料　本组中男２４８例,女２６２例;年龄１４～６４岁。风湿性心脏病４５１例,其中单纯二尖瓣狭窄（ＭＳ）６６例,单纯二尖瓣关闭不全（ＭＩ）５例,ＭＳ＋ＭＩ１７４例,二尖瓣病变（ＭＶＤ）加三尖瓣病变（ＴＶＤ）６３例,主动脉病变（ＡＶＤ）３５例,ＭＶＤ＋ＡＶＤ１０２例,ＭＶＤ＋ＡＶＤ＋ＴＶＤ６例;先天性心脏病３０例,其中ＭＶＤ１０例,ＡＶＤ１０例,动脉导管未闭（ＰＤＡ）…     

二尖瓣替换术后呼吸机依赖21例分析

二尖瓣替换术后呼吸机依赖２１例分析张希龙，高声甫，周采璋，景华，张石江，丁永清体外循环心脏术后呼吸机依赖（ｖｅｎｔｉｌａｔｏｒｄｅ－ｐｅｎｄｅｎｃｙ，ＶＤ）迄今尚无确切定义，参照国外标准［１］，将１９８７年至１９９２年在我院行二尖瓣替换术（ＭＶＲ）后...     

心脏瓣膜病巨大左室的外科治疗经验

１９８７年１月至１９９２年３月，我们为６５例心脏瓣膜病巨大左室（ＥＤＤ＞７０ｍｍ）病人施行了瓣膜替换术。术前平均ＥＤＤ７８．８ｍｍ，ＥＳＤ５７．３ｍｍ，ＦＳ０．２６。心功能ＩＩＩ级１６例，ＩＶ级４９例。手术方式：ＭＶＲ１６例，ＭＶＲ＋ＴＶＰ１０例，ＡＶＲ１１例，ＭＶＲ＋ＡＶＲ２１例，ＭＶＲ＋ＡＶＲ＋ＴＶＰ７例。术后早期发生心、肺、肾、肝等重要器官并发症２７例，死亡９例（１３．８％）。ＡＶＲ组（１８     

二尖瓣置换术后远期功能性三尖瓣关闭不全的外科治疗

目的：报告二尖瓣置换（ＭＶＲ）术后远期三尖瓣关闭不全（ＴＲ）外科治疗的结果及作用,方法：３７例ＭＶＲ术后中重度ＩＲ病人,其中人工二尖瓣为生物瓣者１３,机械瓣２４例,有１１例行内科保守治疗,２６例行外科手术治疗,手术类型,ＭＶＲ加三尖瓣置换２例,ＭＶＲ加三法瓣成形１１例,三尖瓣置换３例,三尖瓣成型１０例,三尖瓣成形术包括改良Ｋay形成形１２例,改良ＤeVega成形术７例,加成形环的三尖瓣成形术２例,结果：１１例内科治疗者,７个月－７．５年后７６例死亡,病死率为５４．５％,26例手术治疗者,术后早期病死２例,病死率为７．７％,随访个月－１０．５年,晚期死亡例,仍中度ＴＲ２例,结论：ＭＶＲ术后远期ＴＲ的产生与不可逆的左心损害或（和）严重肺动脉高压有关,对重度ＴＲ伴有临床症状、左心功能基本正常者,行三尖瓣成形或三尖瓣置换术可取得良好的效果。     

重症心脏瓣膜替换术35例报告

重症心脏瓣膜替换术３５例，占同期心瓣膜直视手术的５０％。其中双瓣膜替换（ＤＶＲ）１６例，巨大心脏行ＷＶＲ１３例，ＡＶＲ２例，二尖瓣闭式分离术后再次换瓣３例，急症换瓣２例。死亡５例，死亡率１４．３％。本文就重症心瓣膜替换术围术期处理及如何加强心肌保护等问题进行了讨论。     

二尖瓣腱索断裂的临床诊断与外科治疗

目的 总结５２例二尖瓣腱索断裂的诊断和外科治疗经验。方法 全组病例均有不同程度的心功能不全。３２例行二尖瓣置换术（ＭＶＲ）,２０例行瓣修复或成形术。结果 术后４８例生存,４例围手术期死亡,病死率７．７％。生存病死例术后随访１～６７个月,除１例风湿性病变者行二尖瓣、三尖瓣成形术术后１年又出现二尖瓣中度关闭不全外,其余心功能均有不同程度改善２。结论 风湿性病变及心内膜炎病人多以ＭＶＲ为宜,退行性病谈及     

房顶及房间隔联合切口置换二尖瓣

目的报告１９９７年３～１２月用房顶及房间隔联合切口为１４例患者行二尖瓣置换术及术后心律随访结果。方法常规体外循环及心肌保护。首先做右心房斜切口，继而行房间隔切口，两切口汇于隔顶后向前切开左房顶３～４ｃｍ。带扣线置于左房顶切口下缘及房间隔作牵引，行二尖瓣置换。随访时复查心电图。结果无左房顶切口出血的病例，除１例术后死于急性肾功能衰竭和呼吸衰竭外，１３例患者恢复出院。随访结果：术前为窦性心律的３例患者术后仍为窦性心律，而术前为心房纤颤的１０例患者中除１例术后恢复窦性心律外，余９例仍为心房纤颤。结论在常规左心房直切口或经房间隔切口显露困难时，房顶及房间隔联合切口是一种较好的选择     

Pulmonary vein isolation for chronic atrial fibrillation associated with mitral valve disease: the midterm results.

OBJECTIVE: The Cox Maze procedure is widely performed for the surgical treatment of atrial fibrillation. However it requires numerous incision lines and therefore is a time-consuming operation. We report a simplified operation for chronic atrial fibrillation associated with mitral valve disease. METHODS: Pulmonary vein isolation procedure was performed on atrial fibrillation associated with mitral valve disease in thirteen patients. This simple procedure consisted of isolation of the four pulmonary veins only. Combined mitral valve surgery involved mitral valve plasty, mitral valve replacement with or without aortic valve replacement and tricuspid annuloplasty. RESULTS: Eleven patients returned to sinus rhythm (84.6%). Mean follow-up time is 32.7 +/- 11.7 months. Three patients required a DDD pacemaker implant for sick sinus syndrome but two out of these three resumed sinus rhythm most of the time recently. Left atrial contraction was detected in eight cases by trans-esophageal echo. One patient died of liver failure two months postoperatively. Eight patients had no blood transfusion. Twelve patients are classified as New York Heart Association class I. CONCLUSION: Compared with the Maze procedure, this operation was less invasive and preserved the atrial appendage and was thought to have a normal level of secretion of atrial natriuretic peptide. This study suggests that the pulmonary vein isolation procedure may be an effective and simple maneuver for atrial fibrillation associated with mitral valvular disease.     

心房纤维颤动的外科治疗

３例采用改良迷宫术探索进行心房纤颤外科治疗获成功。病人术前均为风湿性心脏病，心功能Ⅲ－Ⅳ级，心房纤颤病史３－１０年，左房直径５２－５８ｍｍ，心胸比率０．６４－０．７０。在进行改良迷宫术的同时，２例行二尖瓣替换，１例行双瓣替换及三尖瓣环缩。术后２例自动复跳，１例电击除颤复跳。３例术后早期均为窦性心律。２例术后３年恢复良好，正常心律，心功能Ｉ级；１例术后３个月死于脑血管意外。文中重点介绍了手术方法，提     

Evaluation of superior transseptal approach for the removal of left atrial myxoma

We compared the operative outcomes among 14 patients who underwent the removal of left atrial myxoma with four different approaches; right lateral (n = 2), transseptal bi-atrial (Dubost, n = 4), conventional transseptal (n = 4) and superior transseptal approach (STA, n = 4). Concomitant operations were performed in 4 cases (CABG, two; aortic valvuloplasty, one; mitral valve replacement, one), and two out of 4 cases were in the STA group. The mean operation, cardiopulmonary bypass and aortic cross-clamp times were shorter in the STA group compared to the other three group. The total amount of postoperative drain discharge and the peak value of creatine kinase were also lower in the STA group compared to the other three groups. Among the patients in sinus rhythm before operation, the use of STA was associated with a greater incidence (100%) of postoperative atrial fibrillation or junctional rhythm. These rhythm disturbances were temporary, and all returned to sinus rhythms during hospital stay. We conclude that STA is an excellent approach with a nice surgical view to expose and remove the left atrial myxoma.     

Septal-superior exposure in mitral valve surgery with radiofrequency ablation

BACKGROUND: We review the results of surgical radiofrequency ablation of both atria in patients of mitral valve disease approached by septal-superior exposure and discuss the availability of this approach. METHODS: Eighteen patients with a mean age of 65 years were included in this study. Thirteen patients had mitral valve regurgitation predominantly and five had mitral valve stenosis. Eleven patients underwent mitral valve plasty and valve replacement was carried out in seven. All ablation lesions were created on both atria using radiofrequency energy delivered by a unipolar malleable radiofrequency ablation catheter with seven electrodes at a minimum temperature of 80-85 degrees C for a period of 2 min. RESULTS: At the time of discharge, 14 patients were showed normal sinus rhythm and one patient remained in AF. The other three patients were free from atrial fibrillation; however, they received dual-mode, dual-pacing, dual-sensing pacemaker implantation because of bradycardia during the early postoperative phase. At a mean time of 7 months after surgery, all patients were free from atrial fibrillation; 13 patients showed normal sinus rhythm and five patients received dual-mode, dual-pacing, dual-sensing pacemakers. CONCLUSION: Septal-superior exposure provides an excellent operative view both for mitral valve surgery and for radiofrequency ablation. However, this exposure has not been considered a first-line approach because of the high rate of pacemaker implantation.     

The radiofrequency modified maze procedure. A less invasive surgical approach to atrial fibrillation during open-heart surgery.

OBJECTIVE: Patients with mitral valve disease and suffering of atrial fibrillation of more than 1 year's duration have a low probability of remaining in sinus rhythm after valve surgery alone. Intraoperative radiofrequency ablation was used as an alternative to simplify the surgical maze procedure. METHODS: Seventy-two patients with mitral valve disease, aged 63+/-11 years ranging from 31 to 80 years, underwent valve surgery and radiofrequency energy applied endocardially, based on the maze III procedure to eliminate the arrhythmia. The right-sided maze was performed on the beating heart and the left-sided maze during aorta cross-clamping. RESULTS: Surgical procedures included mitral valve repair (n=38) or replacement (n=34) and in addition tricuspid valve repair (n=42), closure of an atrial septal defect (n=2) and correction of cor triatriatum (n=1). The left-sided maze needed 14+/-3 min extra ischemic time. There were two in-hospital deaths (2.7%) and three patients (4.2%) died during follow-up of 20+/-15 months. Among 67 surviving patients, 51 patients (76%) were in sinus rhythm, two patients (3%) had an atrial rhythm and eight patients (12%) had persistent atrial fibrillation or atrial flutter. Four patients had a pacemaker implanted, in one patient because of sinus node dysfunction. Doppler echocardiography in 64 patients demonstrated right atrial contractility in 89% and left atrial transport in 91% of patients. CONCLUSIONS: Intraoperative radiofrequency ablation of atrial fibrillation is an effective and less invasive alternative for the original maze procedure to eliminate atrial fibrillation.     

Mitral valve replacement with homograft and Maze III procedure

BACKGROUND: Mitral valve disease is often accompanied by atrial fibrillation, which may compromise the patient even after the valvular lesion has been repaired. METHODS: Three patients with rheumatic type mitral valve disease and chronic atrial fibrillation were treated by mitral valve replacement with cryopreserved mitral valve homograft and Maze III procedure, as a method to relieve both the valvular pathology and the rhythm disorder. The patients' clinical courses have been followed for up to 1 year after operation. RESULTS: All patients survived operation, and all have normal sinus rhythm. None are taking cardiac medications. CONCLUSIONS: Long-term treatment with warfarin should not be required, and other cardiac medicines may be eliminated following mitral valve replacement with homograft combined with Maze III procedure.     

Epicardial radiofrequency ablation of both atria in the treatment of atrial fibrillation: experience in patients

BACKGROUND: Despite success with the Maze procedure and its modifications in treating atrial fibrillation, longer procedure times and increased morbidity have precluded widespread use. The operative treatment for atrial fibrillation associated with aortic valve disease and ischemic heart diseases have not been established. We report the early results of epicardial radiofrequency coagulation on both atria and discuss the availability of this procedure. METHODS: The Australasian database of radiofrequency ablation lists 130 patients with established or frequent intermittent atrial fibrillation that underwent various cardiac surgical procedures between March 2000 and March 2002. Forty patients without mitral valve disease underwent epicardial radiofrequency coagulation on both atria. Twenty-eight patients were in established chronic atrial fibrillation, 9 in paroxysmal atrial fibrillation, and 3 patients had atrial flutter. The primary surgical procedures were coronary artery bypass grafting in 19 patients, aortic valve replacement in 9, coronary artery bypass grafting plus aortic valve replacement in 8, and other procedures in 4 patients. RESULTS: The procedure increased the cross-clamp time by a mean of 10 minutes. Three patients required defibrillation postoperatively, within the first 3 months and have since stayed in sinus rhythm. One patient had late atrial flutter that was cardioverted to sinus rhythm. Sinus recovery rate was 93.7% (15 of 16 patients) at 6 months and 100% in 8 patients reviewed at 12 months. Atrial contractility was maintained. CONCLUSIONS: Epicardial radiofrequency coagulation may be a very effective way of converting patients with atrial fibrillation into sinus rhythm.     

Early and late arrhythmias in patients in preoperative sinus rhythm submitted to mitral valve surgery through the superior septal approach

BACKGROUND: It has been hypothesized that the use of the superior septal approach to the mitral valve can lead to postoperative loss of sinus rhythm. This study was undertaken to evaluate the early and mid-term alterations of the cardiac rhythm in patients with preoperative sinus rhythm (SR) submitted to mitral valve surgery through the superior septal approach. METHODS: Seventy-five cases in preoperative SR submitted to primary isolated mitral valve surgery through the superior septal approach constitute the study population. All patients underwent 12-lead electrocardiography on admission, every day after surgery until discharge and every year during the follow-up period. RESULTS: On admission in the intensive care unit, 46 cases maintained their preoperative rhythm, whereas 18 developed a junctional rhythm (JR) and 7 had a first- or second-degree atrio-ventricular block (AVB). Four cases arrived in the unit in atrial fibrillation (AF). On the first postoperative day, these proportions were substantially unchanged, with the only exception being a slight increase in the number of patients in AF. The day before discharge, only 35 of the 74 surviving cases maintained the preoperative SR, whereas 13 developed AF, 10 were in JR, and 16 were in AVB. During the follow-up period (mean, 26 +/- 14 months), the majority of cases (47/74) regained SR; 11 patients had AVB, 3 were in JR, and the remaining 13 were in AF. CONCLUSIONS: The use of the superior septal approach for mitral valve procedures in patients in preoperative SR is associated with minor, transient cardiac rhythm disturbances.     

Combined superior-transseptal approach versus conventional approach for mitral valve surgery.

OBJECTIVE: This study was designed to evaluate the safety and effectiveness of the combined superior-transseptal approach for mitral valve surgery. METHODS: We compared the preoperative status, operative factors, and postoperative outcomes among patients having mitral valve operations with three atrial incisions. The incisions were transseptal (n = 40), combined superior-transseptal (n = 33), and left atrial (n = 22). RESULTS: The cardiopulmonary bypass time and cross-clamp time were significantly higher in the superior-transseptal group compared with the transseptal group. No significant difference in blood loss was found among the three groups. The incidence of sinus node dysfunction in the early postoperative period was more common in the superior-transseptal group. The maintenance of sinus rhythm at the mid-term follow-up in patients with preoperative sinus rhythm was not significantly different among the three groups. On the other hand, a few patients in the superior-transseptal and transseptal groups with the preoperative sinus rhythm developed sick sinus syndrome requiring permanent pacemaker implantation. CONCLUSIONS: The use of the combined superior-transseptal approach was safe and effective, and was not associated with a higher incidence of rhythm disturbance. Because this approach provided an optimal exposure of the mitral valve and subvalvular apparatus, it has been positively adopted for use in patients undergoing complex and difficult mitral valve operation. To use this approach for patients undergoing mitral valve surgery through this approach, however, further follow-up study of the sinus node function is necessary.