儿童主动脉瓣病变成形术

目的：总结主动脉瓣成形术在儿童主动脉瓣病变中的治疗效果。方法：分析33例14岁以下患儿因各种心脏病伴主动脉瓣病变，在本科住院手术的临床资料。其中手术死亡1例，病死率为1．8％。32位患儿术后康复出院，出院复查提示主动脉瓣功能较术前显改善（P＜0．05）。随访无死亡，无再次手术，所有患儿心功能为NYHA Ⅰ级或Ⅱ级。结论：大多数儿童主动脉瓣成形中期效果良好。儿童主动脉瓣病变治疗应首先瓣膜成形。     

经腋动脉入路行经皮主动脉瓣置入术治疗主动脉瓣重度狭窄的安全性和有效性

【摘要】目的 经腋动脉入路行经皮主动脉瓣置入术治疗主动脉瓣重度狭窄的安全性和有效性。方法 回顾性分析多家中心2019年1月至2021年5月行TAVR手术的主动脉瓣狭窄患者135例。根据入路分为2组,经腋动脉入路组11例（11/135,8.1%）,经股动脉入路组124例（124/135,92%）。结果 两组均未出现死亡病例。围手术期内共有1例（1/135,0.74%）患者术后需行ECMO（体外膜肺氧合）辅助循环,发生于经腋动脉入路组,两组间有显著的统计学差异（P＜0.01）。术中左室破裂1例（1/135,0.74%）,中转外科手术1例（1/135,0.74%）,术后致残性脑卒中1例（1/135,0.74%）,均发生于经股动脉入路组,两组比较未见统计学差异。术后外周血管并发症3例（3/135,2.2%）,经腋动脉入路1例（1/11,9.1%）,经股动脉入路2例（2/124,1.6%）,两组比较未见统计学差异。术后起搏器植入10例（10/135,7.4%）,均发生于经股动脉组,两组比较未见统计学差异。结论 经腋动脉入路行经皮主动脉瓣置入术与经股动脉入路有相似的临床结果,是有效及安全的治疗方法。     

主动脉瓣硬化临床危险因素分析

目的通过横断面研究,了解主动脉瓣硬化在一组高危人群中发病情况,并评价主动脉瓣硬化的临床危险因素。方法 1058例首钢社区动脉硬化调查的队列人群,排除了风湿性瓣膜病、主动脉瓣二叶瓣畸形、人工瓣膜置换术后、主动脉瓣狭窄。测定并评价心血管疾病的危险因素(包括年龄、血压、血糖、血脂、体质指数和吸烟情况)。根据经胸心脏超声评价主动脉瓣硬化病变情况,并将人群分为主动脉瓣硬化组和主动脉瓣正常组。结果最终入选1039例人群,平均年龄62.47±8.99岁,明确患有高血压病占68.72%,糖尿病占25.89%。发生主动脉瓣硬化401例(38.59%)。年龄每增加10岁是原来发生瓣膜硬化危险的1.589倍(P<0.001);男性发生瓣膜硬化的危险是女性的2.263倍(P<0.001);患高血压病人群发生瓣膜硬化的危险是无高血压的1.296倍(P=0.063),而患糖尿病的人发生瓣膜硬化的危险是无糖尿病的1.794倍(P<0.001)。经多因素Logistic回归分析,发现主动脉瓣硬化独立危险因素包括年龄增加(OR=1.507,P<0.001)、男性(OR=1.974,P=0.003)、高血压(OR=1.428,P=0.015)和...     

Valve in valve implantation to prevent acute prosthetic valve migration in Transcatheter Aortic Valve Implantation (TAVI)

This case demonstrates the importance of accurate sizing of aortic annulus prior to TAVI. There was migration of first valve after deployment and therefore to prevent further migration to the left ventricle, a new TAVI valve was deployed jailing the first valve.     

Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

Background

Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge.

Objectives

To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI.

Methods

The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)].

Results

The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05).

Conclusions

In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.     

Quadricuspid Aortic Valve with Sinus of Valsalva Rupture

A 22‐year‐old female with no medical history presented to the emergency room with 2 weeks of rapidly worsening dyspnea on exertion, orthopnea, and cough. On cardiac auscultation, she was noted to have to‐and‐fro murmurs and a continuous murmur with signs of right heart failure. Echocardiographic images obtained showed moderate to severe aortic regurgitation, severe tricuspid regurgitation, and a “windsock” originating in the right coronary sinus of Valsalva and terminating in the right atrium. The aortic valve had four leaflets, with the right leaflet function compromised by the ruptured sinus, causing aortic regurgitation. The patient underwent resection of the sinus aneurysm and aortic valve replacement with a bioprosthetic valve. Quadricuspid aortic valves are uncommon and are rarely associated with sinus of Valsalva aneurysm. The prevalence in the general population, clinical progression, and prognosis of this unique congenital abnormality are reviewed.     

Transcatheter Aortic Valve Implantation Complicated By Acute Structural Valve Failure Requiring Immediate Valve In Valve Implantation

The first percutaneous transcatheter aortic valve implantation (TAVI) was performed in 2002 by Alain Cribier with over 10,000 valve implants since. Despite this, as with all new technologies we remain on a learning curve and continue to encounter new challenges and complications. We report a case of acute structural valve failure treated successfully with a second valve in valve implantation of transcatheter aortic valve in a patient who had severe aortic stenosis (AS) complicated by a severely unfolded aorta.     

心室间隔缺损合并主动脉瓣关闭不全的外科矫治

目的：探讨心室间隔缺损（ＶＳＤ）合并主动脉瓣关闭不全（ＡＩ）的外科矫治方法。　　方法：总结１０６例ＶＳＤ合并ＡＩ的外科治疗经验。主要有干下型ＶＳＤ６６例（６２．３％ ）,膜周部ＶＳＤ２２ 例（２０．８％ ）。主动脉瓣以单叶右冠状动脉瓣脱垂为主（７８例占７３．６％ ）;本组单纯ＶＳＤ修补１４ 例;主动脉瓣成形７５例,主动脉成形主要采用脱垂瓣叶折叠悬吊法和中心型折叠法;主动脉瓣置换１７例。　　结果：手术死亡１ 例。出院检查脉压差均恢复正常。心胸比率以及左心室舒张末径均有明显缩小。ＶＳＤ修补术后无残余分流。　　结论：强调早期治疗,防止ＡＩ的进一步发展。主动脉瓣成形是首选方法