Pulmonary and aortic valve endocarditis in an adult patient with silent patent ductus arteriosus

Pulmonary and aortic valve endocarditis are uncommon especially in an adult patient with patent ductus arteriosus. A 27-year-old woman diagnosed with pulmonary and aortic valve endocarditis underwent surgical treatment. Here, we report our clinical and surgical experience in treating a case of double valve endocarditis with clinically silent patent ductus arteriosus.     

右心瓣膜感染性心内膜炎的外科治疗

目的：总结右心系统瓣膜心内膜炎的特点和手术处理经验。方法：回顾性分析右心系统瓣膜感染性心内膜炎１７例,其侵犯三尖瓣６例、肺动脉瓣４例,同时侵犯三尖瓣＋肺动脉瓣３例,肺动脉瓣＋主动脉瓣３例,主动脉瓣、二尖瓣、三尖瓣与肺动脉瓣同时受累１例。合并心脏畸形１４例,室间隔缺损修补术后、主动脉窦瘤破裂修补术后、起博器安置术后各１例。施行三尖瓣瓣膜游离缘或瓣膜赘生物切除直接缝合５例、三尖瓣瓣膜赘生物切除用自体心包片修补２例、部分瓣叶和瓣下结构切除缝合瓣叶并行人工腱索成形术１例,施行三尖瓣置换术２例;单纯行肺动脉瓣瓣叶赘生物切除４例,部分肺动脉瓣切除用自体心包片瓣叶成形术６例,切除肺动脉瓣用自体心包瓣置换１例。结果：术后早期死亡２例,病死率为１２％,术后早期并发急性肾功能不全３例,肝功能不全１例。术后随访５个月～１８年,平均随     

Coexisting bicuspid aortic and pulmonary valves diagnosed by 3D transthoracic echocardiography

Coexisting bicuspid aortic and pulmonary valves is an extremely rare condition, and there have been few published cases. Diagnosis of bicuspid aortic valve is straightforward with 2D echocardiography; however, analysis of the morphology of the pulmonary valve is challenging. In this study, we report on a case of a 32‐year‐old man with bicuspid aortic and pulmonary valves diagnosed by 2D and 3D transthoracic echocardiography. The enlarged pulmonary artery without any obvious etiology led us to suspect a pulmonary valve anomaly; thus, we comprehensively evaluated it with 2D and 3D echocardiography, which confirmed the diagnosis of bicuspid pulmonary valve.     

Aortic allograft (homograft) for the treatment of valvular disorders in adults with focus on treatment of infective aortic valve endocarditis

Still after 40 years of heart valve prostheses intensive development ideal valve substitute still does not exist. Aortic allograft represents one alternative which could be used for aortic and/or pulmonary valve replacement. This type of biological heart valve prosthesis is being currently discussed from the point of view of Tissue Banking, as well as from clinical aspects--e.g. surgical implantation technique and long term results. Live issue remains particularly the aortic allograft implantation into the aortic position. The authors discuss the aortic allograft role in the aortic valve infectious endocarditis treatment, which was widespread worldwide and accepted. Aortic allograft implantation is considered as a method of choice in that particular indication, especially in prosthetic aortic valve endocarditis and in left ventricle outlet tract destruction cases. The method is considered to be more technically demanding than routine heart valve surgery (heart valve replacement by means of mechanical or commercial biological prostheses), but literary and authors own experience in that particular group of patients looks encouraging. Aortic allografts permanent supply in our country is secured.     

Emergent use of retrograde left ventricular support in patients after transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) is currently a therapeutic alternative to open aortic valve replacement for high‐risk patients with severe symptomatic aortic valve stenosis. The procedure is associated with some life‐threatening complications including circulatory collapse which may require temporary hemodynamic support. We describe our experience with the use of the Impella 2.5 system to provide emergent left ventricular support in cases of hemodynamic collapse after TAVR with the Edwards SAPIEN prosthesis.© 2012 Wiley Periodicals, Inc.     

Ross手术的临床应用

目的 :总结我院心外科Ross手术临床应用情况。方法 :8例患者均在全麻体外循环中度低温下进行 ,采用Ross手术方法治疗主动脉瓣病变 ,根据超声心动图检查结果分析手术前后患者的心内结构变化 ,血液动力学变化以及患者的心功能。结果 :全组患者无手术死亡率及并发症 ,术后主动脉瓣跨瓣压差在正常范围 ,为 6 6 5± 1 4 1mmHg,心功能 (NYHA)Ⅱ级 ;3例远期随访中有 1例术后 1年发生同种瓣霉菌性心内膜炎再次手术治疗 ,术后因低心排死亡 ;另 2例随访 8年 ,均存活良好 ,心功能均Ⅰ级 ,主动脉瓣轻度返流 ,左室内径正常、肺动脉瓣均功能良好。 5例近期患者随访 1～ 6个月 ,心功能Ⅰ～Ⅱ级 ,主动脉瓣、肺动脉瓣均功能良好。结论 :Ross手术是一种临床疗效好的矫治主动脉瓣病变的手术方法     

Quadricuspid aortic valve, parossistyc supraventricular tachycardia and double right kidney: an uncommon association

Fourteen years after surgery for replacement of the aortic valve, an interesting case previously unreported was brought to our attention. The female patient came to our OP Dept for a routine follow-up: she had been found at surgery to have a quadricuspid aortic valve. Operation dated October 1985. At a careful appraisal of the world-wide literature, we noticed that such an association of pathologies had never been reported before: quadricuspid aortic valve, paroxystical supraventricular tachycardia and right double kidney with double renal pelvis and double proximal ureter. Other anomalies associated with the quadricuspid valve, available in the literature are: patent duct, subvalvular fixed aortic stenosis, ventricular septal defect, hypoplastic anterior mitral leaflet and pulmonary stenosis. The pathologic findings at autopsy of this congenital malformation vary between 0.008% and 0.033%; attention must be turned to the fact that the incidence can be underestimated if not expressly searched for. The first quadricuspid aortic valve was described in 1862 by Balington in an autoptic report and sixty other cases have been reported since. In rare cases this pathology has been diagnosed at angiography. At follow up our patient remains in SR with rare transitory episodes of supraventricular tachycardia.     

The Ross procedure in the acute phase of infectious endocarditis in childhood]

The Ross procedure of aortic valve replacement with a pulmonary autograft has several advantages in childhood over mechanical prostheses or homografts, especially in infectious endocarditis requiring early surgery. Between January 1997 and July 1998, 3 children with no known previous cardiac disease, aged 14 months, 10 and 11 years, had aortic valve infectious endocarditis. The causal organism was not identified in 1 case and the other two were due to staphylococcus aureus and corynebacterium diphteriae. All children had severe, rapidly progressive aortic regurgitation complicated by pulmonary oedema in the baby and systemic emboli in the two older children. Surgery was performed within 9 days, 1.5 month and 2 months after the onset of the disease. The postoperative course was uncomplicated in the 3 cases. Postoperative Doppler echocardiography showed absence of autograft dysfunction or stenosis, with the presence of pulmonary regurgitation in 1 case. Pulmonary autograft has the advantages of not requiring anticoagulation, of allowing growth of the aortic ring, of not being limited by the age of the patient and of having a low risk of degeneration and infectious endocarditis. Therefore, it seems particularly indicated for cases of complicated infectious endocarditis requiring early aortic valve replacement. The early (4.8%) and late (4.3%) mortality rates were comparable to those of other techniques and are lower than those associated with valve replacement with mechanical prostheses in cases of endocarditis (8.5% versus 40%). The secondary morbidity is 18.8% with dysfunction of the autograft and/or stenosis of the pulmonary homograft. Despite a limited follow-up, aortic valve replacement by a pulmonary homograft seems better than aortic valve replacement with a homograft or mechanical prosthesis, especially in cases of complicated infectious endocarditis requiring surgery in the acute phase. Further studies are required to confirm these encouraging results.     

Long-term surgical prognosis of aortic valve diseases with pulmonary hypertension. Apropos of 34 cases]

Thirty-four patients underwent isolated aortic valve replacement with mean pulmonary artery pressures greater than 40 mmHg between 1972 and 1988. The aortic valve disease was stenotic in 10 cases, regurgitant in 14 cases and mixed in 10 cases. Thirty patients (88%) had invalidating cardiac failure (NYHA Classes III and IV). The mean preoperative ejection fraction was 44 +/- 15%. The hospital mortality was 17.6%. Ten patients died secondarily, five with terminal cardiac failure. The 5 year actuarial survival was 70 +/- 16%; the 10 year survival was 60 +/- 18% with an average follow-up of 115 +/- 61 months. None of the patients was lost to follow-up. Fifteen of the 18 survivors (83%) are asymptomatic or pauci-symptomatic after a follow-up of 126 +/- 62 months. Doppler echocardiography (n = 12) showed normal prosthetic valve function in 11 cases and aortic regurgitation in 1 case. Eight patients had tricuspid regurgitation with pulmonary artery systolic pressures less than 30 mmHg in 6 cases and between 30 and 40 mmHg in 2 cases. Severe pulmonary hypertension is therefore a poor early postoperative prognostic factor in aortic valve replacement surgery due to the associated left ventricular dysfunction. However, the long-term results are satisfactory: clinical improvement is usually related to a reduction of pulmonary hypertension.     

Siena's experience with pulmonary autograft operations: clinical and echocardiographic follow-up

As there is no perfect aortic valve substitute, there is a need to find out which one is the best option to replace the diseased aortic valve. Any type of mechanical or biological stented device has a residual gradient and does not reproduce the extremely sophisticated normal aortic valve function. This may influence the short- and long-term outcome, especially in dilated and poorly contracting left ventricles which do not tolerate even a mild stenosis. Thus, the potentially ideal valve to replace the aortic valve is either an aortic valve (aortic homograft) or a pulmonary autograft in aortic position. These grafts are also less subject to endocarditis. It has been demonstrated that pulmonary autografts can grow when implanted in children and as they remain viable, they maintain their dynamic behavior and possibly the internal innervation of the cusps. Unfortunately, pulmonary autograft surgery is more demanding and lasts longer, which may increase the risk of the operation. In addition, the exact indications and applications of the operation, particularly in patients with poor left ventricles or additional lesions, have not been clearly defined. Here we report our experience with this technique in 11 patients with severe aortic valve disease, including those with poor left ventricle function and/or associated disease. We describe our short- and medium-term follow-up, which shows optimal left ventricle recovery with no perioperative or postoperative complications, thus supporting a wider application of the operation.     

62例室间隔缺损合并主动脉瓣脱垂的外科治疗

目的 总结室间隔缺损（VSD）合并主动脉瓣脱垂的外科治疗经验.方法 2001年1月至2010年12月间,我院收治62例VSD合并主动脉瓣脱垂患者,行单纯VSD心内修复术31例、主动脉瓣置换术（AVR）29例、主动脉瓣成形术（AVP）11例.结果 术后早期死亡2例,1例VSD修补和AVR患者术后3 d因室性心律失常死亡;1例15岁患者,7年前在外院行VSD修复和AVP,复查超声心动图示主动脉瓣重度关闭不全、巨大左心室,再次行AVR,术后1周因心衰死亡.余60例均存活.术后门诊随访,随访时间6个月至10年,共55例,随访率91.7 %.心功能Ⅰ级50例、Ⅱ级5例,均能从事正常生活及学习.1例单纯VSD修复患者出现VSD残余漏,术后1年复查超声心动图示主动脉瓣中度关闭不全,行AVR,目前已治愈.11例AVP患者中,轻度关闭不全8例（2例为肺动脉瓣下VSD,6例为围膜部VSD）;轻-中度关闭不全2例（均为围膜部VSD）;中度关闭不全1例（围膜部VSD）,于术后5年行AVR后治愈.行全迷宫双极射频消融术治疗心房颤动1例,患者心律转为窦性心律.结论 根据主动脉瓣脱垂的程度,合理处理VSD及主动脉瓣病变,可取得满意的疗效.     

Pulmonary atresia and aortic valve stenosis

A case is described of pulmonary atresia with ventricular septal defect and severe aortic valve stenosis. The aortic valve gradient measured at the time of insertion of an aortic to pulmonary arterial shunt was only 5 mm Hg and aortic valvotomy was deferred. Post-operative low output cardiac failure resulted in the death of the patient. The severity of the aortic stenosis was confirmed by post-mortem examination. We suggest consideration of aortic valvotomy in similar cases as the intraoperative pressure gradient may be unreliable.     

Percutaneous treatment of multiple heart defects

We describe our experience in 6 cases with multiple congenital heart defects treated by percutaneous intervention. Their age ranged from 2.3 to 10 years (mean 6.1), with follow-up from 1 to 84 months (mean 28.8). Two cases had coarctation of the aorta (AC) and persistent ductus arteriosus (PDA). Two patients had pulmonary valve stenosis (PVS) and PDA, one case with aortic stenosis (AE) and PDA and one case with AC, mitral stenosis and subaortic stenosis (Shone's Syndrome). Ductus arteriosus was occluded in all patients with Gianturco coils or Rashkind occluder. The valvular gradient post balloon decreased in cases with AC from 46 to 9 mmHg, with PVS from 110 to 10 mmHg and with AE from 40 to 14 mmHg. In a 8 year old boy with Shone's syndrome, we performed angioplasty of aortic coarctation, mitral valvuloplasty with Inoue catheter. He was referred to surgery for subaortic repair stenosis. All are asymptomatic at follow-up. In conclusion; percutaneous intervention is possible in patients with multiple congenital heart defects.     

Rescue “valve in valve” implantation after late onset corevalve cusp rupture leading to acute massive aortic insufficiency

Transcatheter aortic valve implantation (TAVI) has emerged as a feasible and effective alternative to aortic valve replacement in patients at high surgical risk, and is associated with a lower risk of death at 1 year follow‐up when compared with standard therapy. In a recent large study, enrolling 663 high risk patients with symptomatic severe aortic stenosis TAVI with the use of CoreValve system has been associated with early and sustained clinical and hemodynamic benefits, with a cumulative mortality of 15.0% at 1 year follow‐up. This study has shown that paravalvular aortic regurgitation after successful TAVI is a frequent finding, being of mild entity in the vast majority of cases, whereas valvular regurgitation is almost entirely absent or mild. Of note, no cases of structural valve deterioration were reported. We report a case of a successful implantation of a CoreValve that complicated with late onset massive intravalvular aortic regurgitation, due to CoreValve cusp rupture, leading to low output state with acute pulmonary edema, which was successfully treated with “valve in valve” implantation. © 2011 Wiley Periodicals, Inc.     

Ultrasound-guided insertion of pulmonary artery catheter: Case report

This is a case report of a 17-year old girl, who presented with aortic valve regurgitation and patent ductus arteriosus, and she underwent aortic valve replacement (AVR) and (PDA) ligation. Because of the extensive thrill and pulsation in the neck due to carotid artery dilatation, pulmonary artery catheter (PAC) was inserted under ultrasound guidance. This case report is to encourage the use of ultrasound for the safe puncture of internal jugular vein for the insertion of central line and PAC, particularly in the case of aortic valve regurge patients where carotid artery dilatation expected.     

应用自体肺动脉瓣置换病变主动脉瓣（附4例报告）

应用自体肺动脉瓣置换病变主动脉瓣、同种肺动脉瓣原拉重建右室流出道（Ross手术）治疗4例主动脉瓣病变患者,成功3例。1例主动脉瓣二瓣化畸形术后存在轻度主动脉瓣返流。超声心动图均提示主动脉根部及同种瓣良好。1例术中误伤自体肺动脉瓣,改机械瓣置换。认为用自体肺动脉瓣置换病变主动脉瓣效果满意,术中预防自体肺动脉瓣损伤和主动脉瓣返流是手术成功的关键,同种肺动脉瓣原位重建右室流出道可为常规选择的管道。     

Recurrent prosthetic endocarditis in a 21-year old patient with renal transplantation treated with allogeneic homograft

Prosthetic infective endocarditis is a possible complication of implantation of a prosthetic cardiac valve. Without early and effective treatment, it can have fatal consequences. One treatment option is use of an allogeneic cryopreserved homograft. This case report presents a 21-year old patient after kidney transplantation due to hereditary nephrotic syndrome and aortic valve replacement with aortic conduits. After fever was noted in the patient, prosthetic infective endocarditis was diagnosed by echocardiography and also confirmed by CT-3D examination. The cryopreserved aortic homograft was implanted at the Department of Cardiac Surgery. This along with additional conservative management effectively treated the infection. Based on literature data and our own experience, we believe that the treatment of prosthetic endocarditis after aortic valve replacement with cryopreserved homograft can be a method of choice.     

彩色多普勒超声在诊断主动脉窦瘤破裂中的应用

目的:探讨经胸及经食道彩色多普勒超声心动图在诊断主动脉窦瘤破裂的应用价值。方法:用彩色多普勒超声心动图检查有级以上心脏杂音,诊断为主动脉窦瘤破裂合并室间隔缺损(VSD)及主动脉瓣关闭不全的患者,共16例。结果:16例主动脉窦瘤破裂患者中,右冠窦瘤破裂13例,无冠窦瘤破裂3例,合并室间隔缺损9例,合并主动脉瓣脱垂3例,合并肺动脉瓣狭窄及动脉导管未闭各1例。结论:彩色多普勒超声心动图可以直观地显示主动脉窦瘤的有无及其破裂口的大小和数目,还可以对主动脉窦瘤破裂合并心脏畸形的类型作出诊断,很有意义。     

Severe pulmonary hypertension in advanced aortic valve disease.

Review of haemodynamic data of 151 cases with isolated aortic valve disease revealed severe pulmonary hypertension (pulmonary arterial systolic pressure of 60 mmHg or more) in 17 (11%). The left ventricular end-diastolic pressure was high in all but one case, suggesting that the severe pulmonary hypertension was a reflection of the late stages of aortic valve disease. The majority (64.7%) had a low cardiac index. Premature closure of the mitral valve was seen in 12 of the 17 patients. While the incidence of premature mitral closure was the same as in others with mild and moderate pulmonary hypertension, the average reversed ventriculoatrial gradient was higher in the latter groups.     

小儿先天性主动脉瓣病变的个体化治疗

【】 目的 探讨小儿先天性主动脉瓣病变的外科治疗疗效及个体化的治疗方案的临床价值。总结我中心近7年,所收治的17例2个月~16岁以下儿童先天性主动脉瓣疾病个体化治疗的经验及随访结果。 方法 2008年9月至2015年7月期间个体化治疗的17例先天性主动脉瓣病变的患儿。男11例,女6例,年 龄：2月～16岁;体重：(3．1～51)kg。平均(15．6±5．2)kg;年龄分 布：<1 岁：2 例;1～3 岁 2 例,3～16 岁13例。 手术在全麻、低温、体外循环下进行,结合超声、CT及术中情况,手术方案实现个体化。 结果 行主动脉瓣机械瓣置换手术(AVR)3 例,行Bentall术1例,行 Ross 手术2 例,行改良Ross 手术6例,行主动脉瓣成形手术(AVP)5例。 结论 小儿先天性主动脉瓣病变的个体化治疗给外科治疗提供了更好的临床指导意义,而中远期主动脉瓣再次发生病变是影响预后的重要因素,值得进一步研究关注。