19mm和21mm St.Jude主动脉瓣膜置换术后长期随访结果比较

应用小直径人造心脏瓣膜行主动脉瓣置换术后可能会导致左心室流出道残余梗阻,引起心肌肥厚,妨碍术后病情康复,并有可能影响术后长期生存率。该文对229例置换19mm或21mm标准St.Jude瓣膜的患者进行了近15年的长期临床随访、研究。     

St．Jude人工机械瓣膜临床应用20年经验总结

方法 1979年1月至2000年12月,共随访837例瓣膜置换患者,年龄19～84岁,包括主动脉瓣置换478例(378例置换标准St.Jude瓣,78例置换Master系列瓣,22例置换HP系列瓣),其中术前心功能NYHA分级Ⅲ～Ⅳ级,同期行冠状动脉旁路移植术(CABG)150例;二尖瓣置换359例(266例置换标准St.Jude瓣,93例置换Master系列瓣),其中有369例术前心功能NY-     

应用St.Jude双叶瓣行三尖瓣替换术

1979年6月到1992年8月间39例患者采用St.Jude双叶瓣替换三尖瓣,St.Jude双叶瓣27～33mm,手术年龄46±11岁(17～68)岁,其中6例为单纯的三尖瓣替换术(TVR),其余同期或以往行三尖瓣替换术(MVR)和/或主动脉瓣替换术(AVR)。三尖瓣病变为瓣交界融合狭窄4例,其余35例均     

St.Jude瓣用于儿童

生物瓣在儿童中易发生钙化和失功,外科医师趋于应用机械瓣,其预后和抗凝问题引起较多的关注,作者报道了儿童中用St.Jude瓣的经验。     

St.Jude人工瓣在儿童中的应用

病例和方法 自1980年12月～1992年4月20例儿童接受了St.Jude人工瓣置换。年龄2～18岁,男性11例,女性9例,几例(55％)术前心功能Ⅲ～Ⅳ级(NYHA分类)。主动脉瓣置换9例,二尖瓣置换8例,3例为纠正性大血管转位接受了左房室瓣形态上三尖瓣的置换。17例术前有过23次手术。手术采用体外循环和全身低温方法,冷晶体或含血停跳液和心脏表面低温提供心肌保护,所有瓣膜植入均采用连续缝合技术。所有病例的华法令治疗自术后第2天开始,华法令剂量维持凝血酶原时间国际标准化比率(INR)为2～2.5,相当于凝血酶原时间比1.7～1.9。     

St.Jude双叶瓣应用于儿童的经验

随着儿童心脏瓣膜置换术增多,迫切需要经久耐用、血流动力学性能良好及并发症少的人工瓣膜。近年来发展的采用热解碳制作的St.Jude双叶瓣(简称SJ瓣)具有低瓣架和中央血流的特点,且血栓栓塞率低。本组内有数例SJ瓣置换肺动脉瓣后发生急性功能障碍,促使作者对植入SJ瓣的全部患儿回顾分析,以评价其功能。病例和方法:1983年1月至1985年1月间8.0±5.5(0.5～18)岁的36例患儿植入37只SJ瓣,包括     

St.Jude瓣置换双瓣病人的十年随访

作者自1977年10月至1987年10月用St.Jude Medical瓣连续为100例患者行双瓣置换术(DVR)。包括男性41例,女性59例;年龄1～81岁,平均69.86±13.0岁。术前60%患者有明确的风湿性心脏病史,另15%可能有风湿热病史。NYHA 心功能分     

低强度抗凝减少St.Jude瓣并发症发生率

1978年9月至1982年10问采用St,Jude瓣置换主动脉瓣(A组298例)、二尖瓣(B组215例)和双瓣(C组87例),其中男297例,女303例,年龄50.7±9.6(12～83)岁.术后所有患者完成随访,为期122.2±1.1个月。A组、B组和C组的累计随访时间分别为2904.1,1859.1和730人年。采用不同凝血活酶测得的凝血酶原时间转换成国际标化率(INR),     

儿童St Jude Medical机械瓣置换术后10年随访

作者在1979年3月至1988年6月间,成功地应用St.Jude Medica1机械瓣为50例儿童做了瓣膜置换术,年龄4月～15岁(平均7.3±4.4岁),男24,女26,<5岁者占32%。28例二尖瓣置换;17例主动脉瓣置换、1例二尖瓣和主动脉瓣置换;1例二尖瓣和三尖瓣置换;3例左位三尖瓣置换。所有病人均服用抗凝药治疗,40例服华法令;10例作主动脉瓣或二尖瓣置换者服阿斯匹林(10mg/kg/dag)和潘生丁(50～100mg/day)。结果:经手术病人全部存活,无手术死亡.通过补片加宽主动脉瓣环能够置换21mm直径以上的     

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。     

Acute Mechanical Valve Thrombosis of the St. Jude Medical Prosthesis

A bstract From 1986 to 1996, 2585 patients underwent valve replacement with the St. Jude medical prosthesis. Sixty experienced mechanical valve thrombosis. Seventeen of 60 patients (28.3%) had isolated aortic valve replacements, 33 had isolated mitral valve replacements (55%), and 10 had double valve replacements (16.7%) (aortic and mitral valve replacement). All patients who underwent reoperation for mechanical valve thrombosis were functional Class III or IV. Against medical advice, systemic anticoagulation with warfarin sodium had been discontinued or used only intermittently. Thus, anticoagulant activity was not adequate. The diagnosis of thrombosis was made by clinical examination, laboratory findings, and echocardiography and cineradiography. Of the 60 patients, 9 patients died early after surgery or before discharge. Most of the deaths were attributed to low cardiac output. The overall hospital mortality was 15%. The overall 10-year actuarial survival rate was 82.8 ± 1.6%. In our study, reoperation for thrombosed mechanical prosthesis was not an independent parameter determining mortality. Age was the only statistically important hospital mortality predictor. Of this group, 90% suffered mechanical valve obstruction within the first 5 years after operation. These results suggest that valve re-replacement appears to be a suitable surgical treatment for thrombosis of mechanical prosthetic valves, especially in the young. In these patients subsequent anticoagulation management is necessary.     

Clinical Performance of the St. Jude Medical Riata Defibrillation Lead in a Large Patient Population

Clinical Performance of the St. Jude Medical Riata Defibrillation Lead in a Large Patient Population . Objective: The purpose of this large multicenter study was to evaluate the long‐term reliability of an implantable cardioverter defibrillator (ICD) lead to determine the incidence of adverse events (AEs). Background: A recent concern has been the performance of cardiac defibrillator leads. There have been conflicting reports regarding the rate of lead perforation and other AEs. Methods: Medical records from patients implanted from 6‐1‐2001 to 11‐27‐2007 with the St. Jude Medical Riata family of RV leads at 23 US (N = 12,969) and 5 German (N = 2,418) centers were reviewed for chronic lead‐related AEs. These included perforation, dislodgment, conductor fracture and insulation damage. The mean follow‐up period was 18.0 months. AEs were defined as those that required Riata lead revision, extraction, or replacement. Results: The incidence of lead AEs was <1% for each AE type. Perforation occurred in 0.38%, dislodgement in 0.93%, conductor fracture in 0.18%, and insulation damage in 0.21% of patients studied. Conclusions: During the follow‐up of the 15,387 patients with Riata leads, the incidence of AEs which included perforation, dislodgement, conductor fraction and insulation damage was low and within the range of what is considered clinically acceptable. (J Cardiovasc Electrophysiol, Vol. 21, pp. 551‐556, May 2010)     

St.Jude Medical Regent主动脉瓣应用于小主动脉瓣环患者的初步经验

目的总结对小主动脉瓣环患者行St.JudeRegent主动脉瓣替换的初步经验。方法对11例小瓣环主动脉瓣病变患者行St.JudeRegent主动脉瓣替换。患者平均年龄(42.9±13.1)岁,体重(68.2±10.1)kg,体表面积(1.71±0.13)m2。术前主动脉瓣跨瓣峰值压差平均(74.4±34.3)mmHg。替换19号St.JudeRegent主动脉瓣7例,21号4例。结果本组患者无手术死亡,无严重并发症。平均输血量227.3ml,4例未输血。随访无远期死亡。术后患者心功能较术前明显改善。术后6个月复查超声心动图,提示肥厚的左心室显著退缩,人工瓣跨瓣峰值压差为(20.8±5.0)mmHg。19号瓣平均有效瓣口面积为(1.68±0.17)cm2,21号瓣为(1.96±0.25)cm2。结论小瓣环主动脉瓣病变患者行St.JudeRegent主动脉瓣替换的近期效果良好。     

心脏瓣膜组织工程研究新进展

瓣膜置换术是目前临床上治疗心脏瓣膜病的最终手段。但临床应用的各种人工心脏瓣膜在持久性和远期疗效上,都存在着难以克服的缺陷。而随着组织工程技术的发展,组织工程瓣膜以良好的组织相容性、经久耐用且具有生物活性等多方面的优势而成为近年来心脏外科领域的研究热点之一。现综述了近年来国外组织工程心脏瓣膜在瓣膜材料、培养方式及种子细胞等方面的最新进展并展望了该领域的研究未来。     

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)％,...     

通讯作者：修宗谊,Email:13504909539@163.com

目的：提高再次人工心脏瓣膜置换患者的生存率及生活质量。方法：总结2006年5月～2014年5月中国医科大学附属第一医院心脏外科住院再次心脏瓣膜手术患者69例。置换二尖瓣瓣膜31个,修复17个;置换主动脉瓣15个,修复10个;三尖瓣置换3个。术前心功能分级( NYHA)II级22例,III级31例,IV级16例。结果：住院期间死亡5例,死亡率：7.24%(5/69)。术后随访49例(随访率:76.56%),随访时间7个月-8年;随访中再手术6例,死亡7例;存活患者42例,心功能：III级1例,II级12例,余心功能正常。结论：对瓣膜置换术后任何原因导致的重度瓣膜功能障碍,早期诊断、及时采取正确的手术方法将有利于提高患者的生存率。外科手术联合药物治疗是提高术后生存质量的关键。     

Retrograde Transcatheter Closure of Mitral Paravalvular Leak through a Mechanical Aortic Valve Prosthesis: 2 Successful Cases

The presence of a mechanical aortic valve prosthesis has been considered a contraindication to retrograde percutaneous closure of mitral paravalvular leaks, because passing a catheter through the mechanical aortic valve can affect the function of a mechanical valve and thereby lead to severe hemodynamic deterioration. We report what we believe are the first 2 cases of retrograde transcatheter closure of mitral paravalvular leaks through a mechanical aortic valve prosthesis without transseptal or transapical puncture. Our experience shows that retrograde transcatheter closure of mitral paravalvular leaks in this manner can be an optional approach for transcatheter closure of such leaks, especially when a transapical or transseptal puncture approach is not feasible. This technique might also be applied to other transcatheter procedures in which there is a need to pass a catheter through a mechanical aortic valve prosthesis.