风湿性心脏病二尖瓣病变患者瓣膜替换术后肺功能的改变

目的：了解风湿性心脏病二尖瓣病变患者二尖瓣替换术（ＭＶＲ）后肺功能的改变。方法：观察２６例风湿性心脏病二尖瓣病变患者ＭＶＲ术前和术后３～１２个月的肺功能改变。结果：ＭＶＲ后３个月的肺功能与术前相比，无明显好转。术后６～１２个月，患者的各通气功能指标均有明显增加（Ｐ＜０．０５～Ｐ＜０．０１），但肺的一氧化碳弥散功能（ＤＬＣＯ）术后不但无增加，反而有下降的趋势。结论：ＭＶＲ术后３个月患者的肺功能与术前相比，无明显好转，可能与剖胸手术创伤有关。随着心功能的改善，术后６～１２个月，患者的通气功能逐渐改善，但ＤＬＣＯ并不增加，推测可能与患者术后肺泡毛细血管容量减少以及肺组织结构损害不可逆性改变有关。     

1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification

Background

The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures.

保留瓣下结构的二尖瓣替换术后早期效果观察

目的：二尖瓣关闭不全患者行常规二尖瓣替换术后常有左心室功能恶化，有作者推测术中二尖瓣结构的破坏是导致术后左心室功能不全的主要原因之一。本文旨在探讨保留瓣下结构的影响。方法：总结了保留瓣下结构的二尖瓣替换术２６例，其中部分保留２２例为二尖瓣狭窄，完全保留４例为二尖瓣关闭不全。结果：与同期完全切除的２６例（均为二尖瓣狭窄）比较，保留瓣下结构者术后低心输出量综合征发生率较低，左心房缩小较明显，未发生左心室破裂。其余５项指标两组间无差异。结论：二尖瓣关闭不全者应完全保留瓣下结构，其中将人工瓣置入二尖瓣口内更为简便安全。部分二尖瓣狭窄者可保留后瓣及瓣下结构，而瓣叶和瓣下结构病变严重者则应完全切除。     

经导管主动脉瓣膜置换术在重症主动脉瓣膜病中的临床应用

目的 评估经导管主动脉瓣置换术治疗重症主动脉瓣膜疾病患者的临床应用效果.方法 回顾性分析2018年7月至2020年6月期间广州市第一人民医院心脏大血管外科进行经导管主动脉瓣置换术(TAVR)的14例患者,其中男性7例、女性7例,平均手术年龄(69.5±7.5)岁,美国胸外科医师协会STS平均评分(14.1±6.2)％,...     

Short-Term Results on Leaflet Mobility in Patients Undergoing Rheumatic Mitral Valve Repair With an Efficient 4-Step Commissuroplasty Technique

BackgroundMitral valve stenosis (MS) is the primary pathologic feature of rheumatic mitral valve disease, and the complex repair affects its clinical outcome. This study aimed to examine the efficacy of the 4-step commisuroplasty “SCORe” procedure by assessing changes in the mobility of mitral valve leaflets and its clinical effects.MethodsFrom September 1, 2018, to January 13, 2019, patients with MS who underwent mitral valve repair with the SCORe procedure in the study center were analyzed in this prospective study. Mitral valve structure was assessed by transthoracic echocardiography pre- and postoperatively as well as during follow-up.ResultsIn total, 60 consecutive patients were examined. In 56 patients (93.3%), mitral valve orifice area (MVOA) was less than 1.5 cm², and mean (SD) MVOA for the whole cohort was 1.20 (0.34) cm². The mobility of the anterior leaflet was improved (P < .001) during the cardiac cycle postsurgery, but that of the posterior leaflet was not (P = .591). The mean (SD) coaptation length was increased significantly from 6.69 (1.32) mm to 7.92 (1.24) mm (P < .001) postoperatively. Mean (SD) MVOAs increased to 2.24 (0.38) cm2 postoperatively (P < .001). During the 1-year follow-up, there were no deaths or reoperations. Follow-up echocardiography revealed minor or mild regurgitation in 98.3% of patients.ConclusionThese findings demonstrated that the SCORe procedure can effectively improve the mobility of mitral leaflets and enlarge the valve orifice area in patients with rheumatic MS in China, with minimal complications and promising results.     

Risk Factors for Midterm Cardiac Function Deterioration After Valve Replacement Surgery in Patients With Rheumatic Mitral Stenosis

BackgroundA symptomatic reduction in left ventricular ejection fraction (LVEF) is the main reason for postoperative heart failure after valve replacement surgery. However, postoperative heart failure occurs in patients with normal preoperative LVEF. Therefore, we examined clinical and echocardiographic data of patients with rheumatic heart disease to determine additional risk factors for low LVEF in the postoperative period.Methods and ResultsNinety-seven patients with rheumatic heart disease (RHD) who underwent mitral valve replacement for severe mitral valve stenosis were included retrospectively in this study. All patients had normal LVEF before surgery. Patients were divided into 2 groups based on postoperative LVEF 6 months after surgery. Groups A had normal postoperative LVEF (82 cases, 84.5%), and group B had low postoperative LVEF (15 cases, 15.5%). Clinical and electrocardiographic data were collected to determine risk factors for deterioration in cardiac function.Multivariate analysis revealed that preoperative low systolic peak velocities at the lateral tricuspid annulus (St) and no or mild aortic stenosis were independent risk factors for cardiac deterioration in patients with normal preoperative LVEF. Individuals with preoperative St ≤4.8 cm/s were more likely to develop lower LVEF at follow-up (χ² = 7.54; P = .006; odds ratio 5.03, 95% confidence interval 1.31–20.82). All 15 patients who had normal preoperative LVEF but abnormal postoperative LVEF had no or only mild aortic valve stenosis.ConclusionsDecreased right ventricular function and no or mild aortic stenosis were independent risk factors for low LVEF at follow-up in patients with RHD who had normal preoperative LVEF. The velocity of the tricuspid valve ring should be included in preoperative evaluations to improve the accuracy of postsurgical prognosis and clinical decision making.     

Long-term Outcomes of Mitral Valve Repair Versus Replacement for Degenerative Disease: A Systematic Review

The short-term advantage of mitral valve repair versus replacement for degenerative disease has been extensively documented. These advantages include lower operative mortality, improved survival, better preservation of left-ventricular function, shorter post-operative hospital stay, lower total costs, and fewer valve-related complications, including thromboembolism, anticoagulation-related bleeding events and late prosthetic dysfunction. More recent written data are available indicating the long-term advantage of repair versus replacement. While at some institutions, the repair rate for degenerative disease may exceed 90%, the national average in 2007 was only 69%. Making direct comparisons between mitral valve repair and replacement using the available studies does present some challenges however, as there are often differences in baseline characteristics between patient groups as well as other dissimilarities between studies. The purpose of this review is to systematically summarize the long-term survival and reoperation data of mitral valve repair versus replacement for degenerative disease. A PubMed search was done and resulted in 12 studies that met our study criteria for comparing mitral valve repair versus replacement for degenerative disease. A systematic review was then conducted abstracting survival and reoperation data.     

无支架自体心包瓣置换主动脉瓣术后左心功能评价

目的 :评价无支架自体心包瓣植入后血液动力学特性。　　方法 :观察无支架自体心包瓣 (自体心包瓣组 )置换主动脉瓣病人 10例围术期血液动力学指标及术后近期左心功能变化 ,并与双叶机械瓣 (双叶机械瓣组 )置换主动脉瓣病人比较。　　结果 :自体心包瓣组病人围术期血液动力学指标优于双叶机械瓣组 ,而且术后瓣膜有效开口面积大 ,跨瓣压差小 ,病人左心室功能和构型恢复较快 ,2年心包瓣膜功能良好。　　结论 :无支架自体心包瓣具有良好的血液动力学特性 ,手术近期效果满意 ,远期效果有待进一步随访。     

Percutaneous Mitral Valve Replacement Using a Transvenous,Transseptal Approach: Transvenous Mitral Valve Replacement

ObjectivesThe aim of this paper is to describe the feasibility of a novel transcatheter approach for mitral valve replacement using only venous access.BackgroundFailure of mitral valve prostheses necessitating reoperation can represent a high-risk clinical scenario. Although repeat cardiac surgery remains the standard of care for most failed mitral valve operations, nascent transcatheter options are under development for patients at high or extremely risk of surgery. Most often, this is performed via a transapical approach in the operating room, with associated risk of complications as well as extended length of hospital stay.MethodsWe describe a case series of 4 consecutive patients at high risk of reoperation with degenerative mitral prostheses (bioprosthetic valves or rings) who successfully underwent transvenous, transseptal mitral valve replacement with a commercially available transcatheter heart valve.ResultsFrom April to May 2014, 4 consecutive patients underwent transvenous, transseptal mitral valve replacement with a transcatheter heart valve. The mean age was 72 ± 9.9 years, and the average Society of Thoracic Surgeons risk score was 12.5 ± 7.2%. All patients had severe, life-limiting dyspnea. The 4 procedures were successful without intra- or post-procedural complications; echocardiography indicated a well-seated and functioning mitral valve-in-valve or valve-in-ring. Patients were discharged within 2 days after valve replacement with marked improvement in dyspnea.ConclusionsWe describe an innovative technique of transcatheter mitral valve replacement. This case series demonstrates the feasibility of transcatheter mitral valve replacement using only femoral venous access, with a marked reduction in complications and length of hospital stay compared with transapical access or redo surgery.     

Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease

As transcatheter aortic valve replacement becomes a more dominant treatment option across all risk profiles, the frequency of encountering patients with multivalvular disease will increase. Furthermore, percutaneous interventions to treat other valvular lesions are also evolving. Understanding the clinical implications and treatment options for a second valvular lesion is becoming increasingly important to guide heart team decisions, and this paper aims to review the evidence around these situations. Diagnosis of multivalvular disease can be challenging because of changes in physiology. There are little randomized data to guide therapy in multivalvular disease. Multidisciplinary heart team decisions can be invaluable in integrating the plethora of clinical, hemodynamic, and imaging data on which an optimal management strategy can be planned. Prospective studies to assess the role of structural valve interventions in the transcatheter aortic valve replacement era would greatly help improve outcomes for structural heart patients.     

Minimally Invasive Beating Heart Mitral Valve Repair in a Patient With Connective Tissue Disease at Prohibitive Risk for Redo Sternotomy

Sternal reentry when the ascending aorta is adherent to the posterior table of the sternum is associated with substantial risk. A minimally invasive right thoracotomy beating heart approach is an alternative when the aorta cannot be cross-clamped. This report details this technique for a complex reoperative mitral valve repair procedure performed in a patient with connective tissue disease who had required multiple aortic operations and presented with heart failure and severe functional mitral regurgitation.