人工心脏瓣膜的发展概况

自从人工心脏瓣膜和瓣膜置换术问世,患心脏瓣膜疾病的人的存活率,心血管功能及生活质量都有了显著提高。目前,人工心脏瓣膜置换已经成为一项常规的心脏外科手术,世界上每年约有近10万人接受换瓣手术,人工心脏瓣膜已成为一项新兴产业在蓬勃发展。人工心瓣最早是由Harken,接着是Starr于1960年植入人体的。1965年,我国上海长海医院将上海医疗器械研究所和长海医院等     

各向同性碳侧倾碟型二尖瓣的研制

概述自1960年首次研制的人工机械瓣膜成功地应用于临床后,成千上万的瓣膜病人接受了心脏瓣膜置换术,改善或恢复了心脏功能和工作能力。瓣膜置换术已被普遍公认为严重病变瓣膜不能用手术修补和矫正时的有效治疗方法。随着科学技术的发展,近年来人工瓣的类型和结构型式有了很大的发展。人工心脏瓣膜大致有机械瓣和生物瓣两大类,机械瓣又有球型瓣和碟型瓣等型式。我所于1965年研制成功的人工球型二尖瓣成功地应用于临床后,效果显著,存活病人最长已达十四年,迄今健康情况良好。     

奇妙的心音——心脏瓣膜替换术

当人体患了风湿性心脏病并累及到瓣膜,比如二尖瓣、主动脉瓣等,日久天长,心脏瓣膜便失去了它开启、关闭的功能,人的生命也就受到威胁。这时,就需要做心脏瓣膜替换术。就是取下患病的瓣膜,用人工制作的生物瓣或机械瓣取而代之。1960年首次应用瓣膜替换术成功后,揭示了治疗严重心脏瓣膜     

心脏手术, 生物瓣or机械瓣

<正>病人接受心脏瓣膜替换选用何种瓣膜,对病人术后的生存质量具有重要意义。理想的状况是:瓣膜耐用,且不会给病人带来其他麻烦。但目前任何人工瓣膜都不能达到这个要求。人工瓣膜按其制造材料分为机械瓣和生物瓣。机械瓣膜耐久性好机械瓣是由碳材料、金属及人造织物制造的,可持久使用,体外试验时,机械瓣可以承受超过100年的磨损。另外,小口径(19毫米及以下)     

经皮修复瓣膜——未来主动脉瓣的置换

血管支撑机构是治疗瓣膜狭窄的重要工具，大量病人瓣膜疾病的治疗和主要的治疗形式是经皮修复心瓣。使用支架正在被证明是一个重要的治疗方法，在欧洲，使用这些装置进行治疗的占20％。这种新技术有非常好的效果，成本最低，还可减少住院时间。     

心脏内畸形合并感染性心瓣膜炎的外科治疗

目的 探讨心脏内畸形合并感染性心瓣膜炎的诊断及外科治疗特点.方法 回顾1997年2月～2003年2月10例心脏内畸形合并感染性心瓣膜炎患者的临床资料,其中室间隔缺损4例,主动脉窦瘤破裂2例,右室流出道狭窄1例,二尖瓣关闭不全1例,主动脉瓣二叶瓣畸形2例.感染的心脏瓣膜分别为主动脉瓣4例,三尖瓣4例,肺动脉瓣1例,二尖瓣1例.合并瓣膜赘生物9例次,合并瓣膜穿孔4例次,均行外科手术治疗,清除赘生物及修复穿孔,同时行室间隔缺损修补术、主动脉瓣置换术、二尖瓣置换术、右室流出道加宽补片术1例.结果 患者术后7～14 d体温及白细胞计数降至正常,应用抗生素28 d后痊愈出院,全组无死亡病例.结论 心脏内畸形患者并发感染性心瓣膜炎,如发现瓣膜赘生物形成或瓣膜穿孔,应视病情立刻手术或抗感染治疗后手术,术后根据血细菌培养或瓣膜赘生物培养情况应用抗生素28 d,预防人工瓣膜及补片再度感染.     

注意食物对心脏机械瓣膜置换患者抗凝的影响

人造心脏机械瓣膜的出现,为晚期心脏瓣膜病患者带来了福音。自1965年在上海长海医院成功进行了我国首例人造心脏机械瓣膜置换术以来,我国已有成千上万的患者置换心脏机械瓣膜,取得了令人满意的效果。 心脏瓣膜置换术的完成,解除了原有的瓣膜病变,提高了患者的生存质量,但术后还有一个更为关键的问题,即术后的抗凝治疗。机械瓣膜,为非正常心血管     

人工心脏瓣膜置换术现状

心脏瓣膜外科的发展已有50余年历史[1],1953年Gibbon应用人工心肺机于临床,推动了心脏瓣膜直视手术的快速发展,1960年Starr研制和临床应用笼球型人造心脏瓣膜置换二尖瓣获得成功,开创了人造心脏瓣膜的新纪元.1965年蔡用之完成我国首例二尖瓣置换术.随着心外科技术的改进,目前我国每年施行心脏瓣膜手术6000 ～ 7000例,手术复杂程度不断提高,心脏瓣膜外科治疗水平已接近国际先进水平[2].     

心脏术后 我总能听见“哒哒”声

<正>"哒哒哒……"去年底在浙江医院做了心脏二尖瓣置换手术的老吴在安静时总能听到自己心脏发出机械声,这让他有些担心,遂来到浙江医院心脏大血管外科咨询:"医生,我之前做了心脏瓣膜二尖瓣置换手术,安静休息的时候,听得到‘哒哒’声,这种情形正常吗?每个置换心脏瓣膜的患者都会这样吗?"并不是每个置换心脏瓣膜的患者都会如此。人工心脏瓣膜分为生物瓣膜与机械瓣膜。生物瓣膜是     

第三代新型人工心脏瓣膜诞生

上海医疗器械研究所和浙江医科大学附属第二医院及上海901厂的科研人员潜心合作，终于在第三代人工心脏双叶瓣膜研制上取得突破性进展。日前，两例在杭州接受全热解碳双叶型人工心脏瓣膜替换后的病人经临床观察一年后，康复情况良好。人工心脏瓣膜历经第一代笼球瓣、第二代草叶瓣后，第三代人工心脏瓣膜以其全热解碳材料和优秀设计，比目前国际通用的部分热解碳材料的双叶瓣膜更进一步。这种新型人工心脏瓣膜具有以下特点：无菌、无毒，无放射性、不致癌，不引起血凝；双叶双阀门结构使得血液动力学性能更接近人体正常瓣膜；热解碳材料质地…     

心脏机械换瓣术后妊娠妇女孕期处理效果的临床观察

目的:探讨心脏机械瓣膜置换术后妊娠妇女孕期终止妊娠的方式、孕期抗凝以及母婴并发症。方法:对32例次有记录换瓣术后妇女妊娠期的处理进行回顾性分析。结果:32例次妊娠中,14例次非意愿性妊娠,2例人流后放置曼月乐环效果好;整个孕期均常规应用华发林抗凝,无1例孕产妇发生瓣膜血栓和栓子栓塞并发症,胎儿发生流产3例,死胎1例,畸形2例。15例次晚期妊娠,11例择期剖宫产,其中1例发生产后大出血,1例急诊剖宫产出现产后大出血,3例阴道分娩中1例产后大出血;1例孕妇中孕引产过程中发生心衰,同时产后大出血。结论:换瓣术后生育年龄妇女急需有效控制生育,曼月乐环可能满足她们的需要;孕期单一、小剂量华发林抗凝对孕产妇比较安全;终止妊娠方式宜选择择期剖宫产。     

组织工程心脏瓣膜研究新进展

目前临床应用的人工心脏瓣膜,无论是机械瓣还是生物瓣,在瓣膜的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,组织工程瓣膜以其良好的组织相容性、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。本文对近年来组织工程心脏瓣膜在支架材料、种子细胞、动物试验、临床应用等方面进行综述,并指出目前研究中所存在的问题。     

术中经食管超声心动图对心脏瓣膜置换术后即刻评估的价值研究

目的:研究术中经食管超声心动图对心脏瓣膜置换术(HVR)后即刻评估的价值。方法:选取168例行心脏瓣膜置换术患者,均在术中行经食管超声心电图检查,记录主动脉瓣环内径及钙化斑块情况,计算主动脉瓣内直径;观察并记录心脏收缩功能情况,血管内血栓、钙化及钙化斑块大小情况;术后观察人工瓣膜是否成功,重点分析心脏收缩、血容量及瓣膜闭合等情况。比较所有患者手术前后的瓣膜及心功能情况,分析术中经食管超声心动图对HVR术后即刻评估的价值。结果:经食管超声心动图三维检查检测的主动脉瓣环内径及钙化检出情况与手术病理结果相比,差异无统计学意义。在术中行经食管超声心动图发现,2例患者存在生物瓣瓣叶脱垂及缝线勒住生物瓣瓣脚情况,为在机体应力状态下人工瓣膜对合不良影响瓣叶功能,遂均更换相同型号瓣膜,更换后瓣环内反流消失。168例患者术后主动脉平均跨膜压差明显低于术前水平,左室射血分数及有效瓣口面积指数水平明显高于术前,差异有统计学意义(t=20.352,t=32.784,t=22.583;P<0.001)。所有患者均完成HVR,其中6例患者(生物瓣瓣叶脱垂1例、缝线勒住生物瓣瓣脚1例、拆除后离体检测碟片运动无异常的主动脉瓣机械瓣关闭不全1例、机械瓣碟片启闭不灵活且经调整碟片方向仍无改善的二尖瓣3例)更换新的人工瓣膜。所有患者术后恢复顺利,未发生院内死亡。结论:经食管超声心动图应用于HVR术中的临床价值较高,可及时确定人工瓣膜功能异常,协助判断内源性因素并给予及时补救,有助于为提高手术有效保障,对临床治疗效果进行真实性评估,有效提高HVR成功率。     

Protein C,S and antithrombin III levels in patients with acute mechanical valve thrombosis

BACKGROUND: Mechanical prosthetic heart valve thrombosis is a serious complication with an incidence of 1-6%. The reduction in active vitamin-K dependent protein C and S levels caused by warfarin treatment also results in a prothrombotic state. This study was conducted to investigate the connection between protein C (PC), protein S (PS), antithrombin III (ATIII) deficiency and prosthetic mechanical valve thrombosis. METHODS: Twenty-nine of the 283 patients who underwent valve replacement with St. Jude medical prosthesis had mechanical valve thrombosis (group 2). The rest were considered as group 1. Twelve of the 29 patients (41.4%) had isolated aortic valve replacement, 12 had isolated mitral valve replacement (41.4%) and 5 patients had double valve replacement (17.2%). Most of the patients had rheumatic valve disease at their 1st operation. The mean time of occurrence for mechanical valve occlusion was 4.1+/-1.0 years following surgery. RESULTS: The values of PC, PS and ATIII were obtained when the mechanical valves stuck or at routine follow-up. PC, PS and ATIII levels were significantly lower in the mechanical valve thrombosis group. PC levels were 75.4+/-37.6% and 49.9+/-32.2% in group 1 and 2, respectively (p=0.001). PC, PS and ATIII values were mostly lower in the 2nd group but this difference only became significant after at least 2 years of warfarin usage. CONCLUSIONS: Natural anticoagulant levels can be low during the use of warfarin. In which case the dose can be increased in order to hold the international normalized ratio (INR) at 3-3.5. However, more frequent follow-up is required and patients should be investigated for hypercoagulation states or deficiency in anticoagulant proteins. Patients referred to hospital with any mechanical valve thrombosis or recurrent thromboembolism should be evaluated for hypercoagulant proteins.     

Group B streptococcal endocarditis.

A retrospective study of group B streptococcal endocarditis during 1965-74 in Aberdeen General Hospitals revealed that group B streptococci how principally affect patients in the older age groups with or without a history of antecedent heart disease. Despite recent reports of increased group G infections in obstetric and perinatal practice there were no cases of post-puerperal endocarditis. Although aortic valve involvement would appear to be increasing, group B streptococci still show a marked predilection for the mitral valve.     

Bayesian multinomial probit modeling of daily windows of susceptibility for maternal PM2.5 exposure and congenital heart defects

Epidemiologic studies suggest that maternal ambient air pollution exposure during critical periods of pregnancy is associated with adverse effects on fetal development. In this work, we introduce new methodology for identifying critical periods of development during post‐conception gestational weeks 2–8 where elevated exposure to particulate matter less than 2.5 µm (PM_2.5) adversely impacts development of the heart. Past studies have focused on highly aggregated temporal levels of exposure during the pregnancy and have failed to account for anatomical similarities between the considered congenital heart defects. We introduce a multinomial probit model in the Bayesian setting that allows for joint identification of susceptible daily periods during pregnancy for 12 types of congenital heart defects with respect to maternal PM_2.5 exposure. We apply the model to a dataset of mothers from the National Birth Defect Prevention Study where daily PM_2.5 exposures from post‐conception gestational weeks 2–8 are assigned using predictions from the downscaler pollution model. This approach is compared with two aggregated exposure models that define exposure as the average value over post‐conception gestational weeks 2–8 and the average over individual weeks, respectively. Results suggest an association between increased PM_2.5 exposure on post‐conception gestational day 53 with the development of pulmonary valve stenosis and exposures during days 50 and 51 with tetralogy of Fallot. Significant associations are masked when using the aggregated exposure models. Simulation study results suggest that the findings are robust to multiple sources of error. The general form of the model allows for different exposures and health outcomes to be considered in future applications. Copyright © 2016 John Wiley & Sons, Ltd.     

心脏机械瓣膜置换术后患者居家自我管理行为现况调查

目的了解心脏机械瓣膜置换术后患者自我管理行为水平,为提出有效的自我管理教育内容提供依据。方法采用便利抽样法,抽取厦门市某三级甲等综合性医院心脏机械瓣膜置换术后患者106例,采用《心脏机械瓣膜置换术后患者自我管理行为问卷》进行调查。结果心脏机械瓣膜置换术后患者自我管理行为得分为(4.45±0.60)分,处于高水平,其中各维度得分从高到低依次为:治疗依从性管理行为得分为(4.77±0.71)分、症状管理行为得分为(4.59±0.76)分、日常生活管理得分为(4.58±0.65)分、信息管理行为得分为(4.19±0.97)分及情绪管理得分为(3.85±1.16)分。结论心脏机械瓣膜置换术后患者总体自我管理水平较好,但在信息管理及其情绪管理行为方面有待进一步提高;在今后的延续护理照顾方案中,应该注重提高其自我管理能力,加强信息及情绪管理能力。     

A method of determining the feedback resistance of artificial heart valves

Methods to check the back-feed resistivity of the artificial heart valve in static mode have been worked out. These methods allow one to check the resistivity of the closed valve to the revert liquid flow or liquid leakage through it when the new prostheses are tested. The comparative tests of two biovalves and eight mechanical prostheses were carried out. It was stated that among the mechanical valves, which are most widely used in the hospitals (disk, ball and triaflet) the highest resistance when closed has the silicon ball aortic valve AKCh-4-0.6 (Sh).     

Porcine bioprosthetic aortic valve endocarditis with ring abscess and aortic stenosis

Porcine bioprosthetic valve endocarditis is an infrequent but serious complication of valve replacement surgery. Ring (or annular) abscess is a frequent finding in mechanical valve endocarditis. In contrast, porcine valve endocarditis most often involves the cusps, and annular infection is uncommon. Porcine valvular dysfunction secondary to endocarditis usually takes the form of incompetence, whereas stenosis is less frequent. We report a case of a 76-year-old female who developed endocarditis with Staphylococcus epidermidis nine months after placement of a Carpenter-Edwards porcine aortic valve. Her initial presentation included complete heart block and moderate aortic stenosis. Transesophageal echocardiography aided the diagnosis by demonstrating large vegetations, while transthoracic echocardiography showed only slight thickening of the valve leaflets. At operation, there was a circumferential abscess around the sewing ring causing valve dehiscence and virtual discontinuity of the aorta from left ventricle. Valve degeneration and organisms within the cusps were observed on microscopy. This case illustrates two infrequent complications of porcine aortic valve endocarditis, namely massive annular abscess with invasion of the conducting system and aortic stenosis. It also demonstrates the utility and limitations of transesophageal echocardiography in the diagnosis of this disorder.     

The incidence of endocarditis caused by a prosthetic valve and its risk factors

To study the incidence and risk factors of prosthetic valve endocarditis (PVE) we followed 99.5% of 912 patients who had valve replacement from January 1, 1981 through December 31, 1985, for 1 to 6 (mean 3) years. PVE occurred in 27 patients (2.96% or 0.98% per patient-year). The incidence of PVE in the aortic position (3.9%) was significantly higher than in the mitral position (1.5%): p less than 0.25. PVE developed in 19 out of 329 patients with bioprostheses (5.8%) and in 8 out of 583 patients with mechanical valves (1.4%): p less than 0.005. Actuarially at 5 years follow-up 90.7% of the bioprosthetic group and 98.4% of the mechanical valve group was free of PVE (p less than 0.01). Bioprosthetic valve replacement in infective endocarditis further increased the risk of PVE compared to valve replacement by mechanical prostheses. In conclusion: in order of importance antecedent endocarditis, bioprostheses, male sex and aortic position are risk factors in the development of PVE. In patients requiring operation for infective endocarditis, mechanical valves are recommended. As the outcome of PVE is still very grave, authors stress the importance of prophylaxis, early diagnosis and timely operation.