心脏瓣膜替换术122例分析

本院自１９８４年３月至１９９２年１２月，应用侧倾碟瓣、牛心包生物瓣和Ｓｔ．Ｊｕｄｅ瓣施行心脏瓣膜替换１２２例。除１例外，病因均为风湿性病变。二尖瓣替换９６例，双瓣膜替换１７例，主动脉瓣替换９例。心功能（ＮＹＨＡ）Ⅲ级者７８例，Ⅳ级者２１例。术后１个月内死亡１５例（１２．３％）。死亡原因主要为心室颤动，细菌性、霉菌性心内膜炎，低心输出量综合征等。８３例随访６～９６个月，晚期死亡５例。余均症状改善，多数已恢复工作。本文还就换瓣手术指征，心室颤动的原因，重症患者机械呼吸的应用，术后心内膜炎等问题进行讨论。     

近期人造心脏生物瓣膜在瓣膜外科的应用

我们近年来在瓣膜替换术中应用人工生物瓣的例数有逐年增多的趋势。目的　评价人造心脏生物瓣膜在瓣膜外科中的应用趋势。对象　我院自1998年 1月～ 1999年 12月共有 9例患者行生物瓣替换手术。风湿性心脏病 5例 ,退行性变 2例 ,冠心病 2例。方法　全组 9例二尖瓣替换均采用MedtronicHankockⅡ型生物瓣 ,5例 2 7号 ,4例2 9号。结果　本组手术无死亡。术后均口服华法令抗凝治疗。术后B型超声心动图提示瓣膜功能良好。随诊近 1年结果令人满意。结论　由于生物瓣应用于老年人有良好的耐久性 ,同时可以避免因抗凝治疗出现的各种并发症。因此 ,随着生物瓣的防衰坏处理的不断进展、再手术技术的不断提高、对生活质量的日益重视和经济的发展 ,人造心脏生物瓣膜将会得到重新的评价和更广泛的应用     

重症心脏瓣膜病患者行瓣膜替换术体外循环管理体会

报告８６例重症心脏瓣膜病患者瓣膜替换术的心肌保护及体外循环情况。认为除了注间手术时机的选择、手术方法的改进及术后管理外，还应强调术前、术中的心肌保护。     

巨大心脏瓣膜替换术的临床实践

目的：为降低巨大心脏瓣膜替换术病人的手术死亡率，减少术后并发症的发生，从手术时机的选择，术中心肌保护，手术技术操作和术后处理等方面进行探讨。方法和结果：回顾性分析我院1991年7月－2000年12月76例巨大心脏瓣膜替换术的临床资料，术后发生低心排综合症者18例，严重心律失常者5例。肾衰死亡者2例，顽固性心衰死亡者9例，手术死亡率14．5％，余者均痊愈出院，出院前复查胸片，心胸比例平均下降15．8％，超声心动图提示左房内径、左室舒张末期内径较术前明显缩小，射血分数提高，但均未达到正常范围。结论：术前使全身及心功能储备达相对最佳状态，术中注意心肌保护和解剖畸形的合理校正以及适当的术后早期处理，对降低巨大心脏瓣膜替换术病人的手术死亡率、减少术后并发症的发生至关重要。     

390例巨大心脏瓣膜替换术中体外循环管理经验

本文报告了390例巨大心脏瓣膜替换术体外循环管理及心肌保护的方法。一般情况本组男性158例，女性232例，年龄17～70岁，体重38～90kg，心功能Ⅱ级73例，Ⅲ级229例，Ⅳ级88例。心胸比率07～0．79者280例（71．8％），0．8～0．89者97例（249％），大于0．9者13例（3.3％）。有记录的左室舒张末期内径，见表1。体外循环时间57～329分，平均时间112分。心肌血运阻断时间28～270分，平均时间86分。手术种类见表2。表1左室舒张末期内径表2手术种类注：MVR二尖瓣替换术，AVR主动脉瓣替换术DVR双瓣替换术，TVR三尖瓣替换术方法本组均应用性能…     

49例儿童心脏瓣膜替换术的经验

目的：报告儿童心脏瓣膜替换术的经验。方法：４９例儿童心脏瓣膜替换者，男３４例，女１５例，年龄５～１４（平均１１６）岁。其中行二尖瓣替换术３２例、主动脉瓣替换术１０例、二尖瓣加主动脉瓣双瓣替换术５例、三尖瓣替换术２例，所用心脏瓣膜均为机械瓣。同期处理合并的心脏病变。结果：术后早期并发症包括：低心输出量综合征５例，呼吸衰竭２例，心律失常２例。其中早期死亡３例，死亡率６１２％。随访０５～１３（平均５４７）年，晚期死亡３例（６５２％）。结论：儿童心脏瓣膜替换时，人工心脏瓣膜尽量选用成人型号，术后常规行华法林抗凝，并要重视对风湿性心脏病瓣膜替换患儿风湿活动的治疗     

心脏三瓣膜替换6例分析

1994- 0 1～ 1999- 0 4,我科为风心病患者同时行三瓣膜替换术 6例 ,现报道如下。1　临床资料　本组 6例均为女性 ,年龄 2 7～ 5 7岁 ,病程 2～30年 ,其中 1例曾行二尖瓣直视成形术。术前心功能(NYHA)均为 级 ,房颤心律 ,心胸比率大于 0 .7,心源性恶液质 5例。超声心动图示二尖瓣、主动脉瓣病变严重 ,三尖瓣前瓣缩小 ,中、重度返流。　　经长时间术前准备 ,瓣膜替换术在常规体外循环下进行。 5例直接行三瓣膜替换 ;1例先行双瓣替换 ,三尖瓣改良Devega法成形失败 ,在并行循环下行三尖瓣替换。 5例三瓣均选用机械瓣 ,1例主动脉瓣、二尖瓣选…     

巨大心脏瓣膜替换术58例临床分析

<正> 从一九九二年七月至一九九九年十二月共行心脏瓣膜替换术718例.其中巨大心脏(心胸比例>70%)58例占同期心脏瓣膜替换术的8.7%,手术死亡率13.8%.现对降低手术死亡率减少术后并发症,围术期处理体会进行讨论.1 临床资料及分析本组58例,男33例,女25例.年龄35～65岁,病程5～38年.Marfan’s综合征2例,Ebstein2例,余均为风湿性心脏瓣膜病.全部病例心胸比例0.70至0.93,其中左房内径≥80mm(最大达140mm)占56.7%,左室舒末内径≥80mm占21%,心功能Ⅱ～Ⅳ级(NYHA)分级,肺动脉平均压40mmHg～82mmHg(1mmHg=0.133kPa),肺活量占预计值的34%～70%,最大通气量占预计值的38%～85%,     

心脏瓣膜替换术80例体会

作者１９８９年１０月－１９９３年６月行人工心脏瓣膜替换术８０例（共９３个瓣）的治疗体会。男３５例，女４５例，年龄６～５９岁。包括二尖瓣替换５２例，主动脉瓣替换１５例，二尖瓣、主动脉瓣双瓣替换１３例。住院死亡７例，死亡率为８．７５％。文章对术后早期并发症的预防和术后抗凝问题进行了简要讨论。     

超滤在心脏瓣膜替换术体外循环中的应用

目的:探讨超滤在重症心脏瓣膜替换术体外循环中的应用。方法:对52例重症心脏瓣膜替换术患者在体外循环中应用了超滤法脱水技术。超滤时间为10～50分钟,滤出液量800～4200 ml,平均2200 ml,转中红细胞压积(Hct)维持在17％～22％。结果:Hct提高4±2％,所有病人术后恢复平稳,痊愈出院。结论:超滤法可迅速排除体内过多水分,减轻各脏器水肿,有利于心、肺功能恢复,提高手术的安全性。     

生物瓣应用于老年心脏瓣膜置换术的临床总结

目的 探讨老年心脏瓣膜病患者应用生物瓣置换的价值.方法 对36例老年患者施行生物瓣膜置换术,其中行二尖瓣置换18例,主动脉瓣置换10例,二尖瓣及主动脉瓣置换8例;同期行三尖瓣成形术12例,冠脉搭桥术6例.结果 本组围手术期死亡2例.出院后随访1～48个月,心功能恢复至Ⅰ级9例、Ⅱ级21例、Ⅲ级2例.结论 老年患者应用生物瓣具有良好的耐久性,并可避免因抗凝治疗出现的各种并发症,临床应用值得推广。     

Transcatheter aortic valve in valve implantation with bioprosthetic valve fracture

Valve‐in‐valve transcatheter aortic valve replacement (VIV TAVR) has emerged as a preferable option for high surgical risk patients requiring redo aortic valve replacement. However, VIV TAVR may restrict flow, especially in small native aortic valves. To remedy this, bioprosthetic valve fracture has been utilized to increase the effective orifice area and improve hemodynamics. We present three cases in which bioprosthetic valve fracture was used to increase hemodynamic flow in VIV TAVR procedures.     

白塞病心脏瓣膜损害的超声表现

目的　加深对白塞病 (BD)心脏瓣膜损害的认识。方法　分析于 1990 - 11～ 2 0 0 3- 0 6间广东省人民医院收治的 5 0例BD中 13例心脏瓣膜损害患者的超声结果并与手术对照。结果　 (1)BD心脏瓣膜损害并不少见 ,超声发现 2 6 % (13/ 5 0 )BD患者有心脏瓣膜损害。 (2 )BD心脏瓣膜损害的形态学改变主要为脱垂、穿孔及撕裂 ;功能改变主要为瓣膜关闭不全。 (3) 5例患者行人工瓣膜置换术 ,4例需要再次换瓣。结论　超声心动图检查为BD的心脏瓣膜损害提供了形态及功能方面的重要信息。     

Reappraisal of mechanical tricuspid valve replacement in the current era: a single center retrospective study

BackgroundThis study aimed to investigate the early and late outcomes of mechanical tricuspid valve replacement (mTVR).MethodsWe evaluated 113 patients (82 women; median age, 53 years) who underwent mTVR between 1995 and 2017. Based on a history of cardiac surgery, patients were divided into primary (n=42) and reoperative mTVR (n=71) groups. The median follow-up duration was 12.7 years in primary and 9.3 years in reoperative mTVR, respectively (P=0.045).ResultsPatients in the reoperative group were older (54 vs. 46 years; P=0.007) and showed higher central venous pressure (16±6 vs. 13±6 mmHg; P=0.002) than the primary group. Early mortality occurred in 2 patients in the reoperative group (2 vs. 0; P=0.529). There was no significant difference in overall survival between the primary and reoperation groups (15-year survival rate: 86% vs. 78%; P=0.215). The independent risk factors of overall survival were age [P<0.001; hazard ratio (HR), 1.11; 95% confidential interval (CI), 1.05–1.18], left ventricular ejection fraction of less than 40% (P=0.001; HR, 5.1; 95% CI, 2.21–28.2), and central venous pressure over 20 mmHg (P=0.016; HR, 3.7; 95% CI, 1.28–10.7). Overall survival did not differ between the age groups (<60 vs. 60–70 years) in the reoperative group (P=0.772). Tricuspid valve thrombosis occurred in 8 patients (7 primary, 1 reoperative; P=0.004).ConclusionsThe incidence of tricuspid valve thrombosis was significantly higher in the primary mTVR group compared with the reoperative mTVR group. The patients who underwent mTVR at a relatively young age showed good early and late outcomes in both groups.     

单中心61例经导管主动脉瓣置换的结果分析

目的 分析单中心经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的临床效果,总结相关经验,以提高心脏瓣膜介入手术治疗的信心。方法 回顾性分析2020年1月-2021年4月在本中心行TAVR治疗的61例重度主动脉瓣狭窄（aortic valve stenosis,AS)患者的临床资料,分析患者的基本资料、术中并发症情况、术后超声心动图、手术成功率、死亡率等,并观察随访期间严重心血管并发症等不良事件发生。结果 全组患者均使用自膨胀式瓣膜,均经股动脉途径。患者平均年龄(76.1±2.7)岁,其中男性38例,胸外科协会(society of thoracic surgeons,STS)平均分数(9.7±5.6)。60例患者应用一个瓣膜,1例患者采用“瓣中瓣”技术应用第2个瓣膜。术中无患者死亡,无中转外科主动脉瓣置换术(surgery aortic valve replacement,SAVR),术中预扩张球囊平均大小(19.5±2.2) mm,瓣膜植入平均深度为瓣环下(4.2±3.1)mm;术后轻中度瓣周漏2例,中度瓣膜返流1例,脑卒中发生1例,永久性心脏起搏器植入2例,术后早期因脑卒中死亡1例;超声心动图显示术前、术后平均跨主动脉瓣压(mean pressure gradient,MPG)分别为(68.7±20.3)mmHg和(8.1±3.6)mmHg(P<0.05),术前、术后瓣口流速分别为(4.8±0.4)m/s和(1.2±0.3)m/s (P<0.05)。随访3个月内,左心室射血分数均较术前显著提高(P<0.05),无严重心血管并发症等不良事件发生。结论TAVR对我国重度AS患者具有较高的安全性及有效性。随着手术技术的改进,操作流程的优化,对危险因素的干预,TAVR将会是中高风险AS患者首选的治疗方法。     

外科生物瓣毁损患者使用Venus-A人工瓣膜行经导管主动脉瓣置换术术前CT评估的方法与效果

目的 探讨术前计算机断层扫描(CT)评估外科主动脉生物瓣环内径中多平面曲线瓣环测量法及三维重建法测量间的差异以及基于CT结果指导外科生物瓣毁损患者使用Venus-A瓣膜行经导管主动脉瓣置换术(TAVR)的有效性及安全性.方法 回顾性分析2013年3月至2019年10月连续10例在外科毁损生物瓣中采用Venus-A瓣膜行...     

Early and late results after bioprosthetic cardiac valve replacement

In analysing early and late results of 686 bioprosthetic and643 mechanical heart valve implants, we found an early mortalityrate of about 9.0% for single and close to 20% for multiplevalve replacement. Whereas early mortality seems not to be valverelated and is equal for mechanical and bioprosthetic valves,late mortality is influenced by the type of valve implanted,since mechanical prostheses require long-term anticoagulationand are more likely to cause thrombus-formation. More attention should be drawn to the optimal timing of surgerybecause function of the myocardium at the time of operationsignificantly influences early and late results of valve replacement.To improve results further, durability and performance characteristicsof bioprostheses should be constantly analysed. Since valvedurability depends on the stability of the tissue at the timeof implantation and not on regeneration, function-time of bioprostheseswill be limited. Nevertheless, the possibility of an eventualreoperation seems to be less dangerous than the constant riskof thromboembolic and bleeding complications in patients withmechanical valves.     

Early and late results of combined mitral-aortic valve surgery

OBJECTIVE: This retrospective study was designed to assess the early morbidity and mortality as well as long-term mortality of combined aortic-mitral valve procedures at a single centre. METHODS: Patients were identified by analysing the intensive care and perfusion databases, from 1989 to 2003, with 113 receiving aortic-mitral valve procedures. Eighty-four percent of patients received a mechanical bileaflet valve. Survival was assessed using a Kaplan-Meier method, and determinants of survival with the Cox proportional hazards model. RESULTS: There were 57 men and 56 women, median age 59 (18-84) years. The 30-day mortality was 9% (n=10). This cohort contained a number of high risk patients, 38% were classified as New York Heart Association class IV, 33.5% had at least moderate ventricular impairment, 20% were redo procedures and 17% urgent procedures. Survival estimates at 5 and 10 years were 85% (0.76-0.90) and 65% (0.49-0.77), respectively. Multivariate pre-operative predictors of death included renal dysfunction (creatinine >200 micromol/L) and hypertension. Rheumatic aetiology was associated with improved survival. CONCLUSION: This study shows acceptable short and long-term survival in patients undergoing combined aortic-mitral valve surgical procedures at a single centre. Renal impairment and hypertension were associated with a poorer long-term prognosis and rheumatic aetiology was associated with improved survival. Age, LVEF and NYHA class were not associated with a worse outcome. This may affect future decision making in light of an aging population.     

Malaligned bioprosthetic valve causing left ventricular outflow tract obstruction

Left ventricular outflow tract obstruction resulting from strut impingement upon the interventricular septum is a rare complication of bioprosthetic mitral valve insertion. Obstruction is more likely to develop when a small, high profile prosthetic valve is inserted into a patient with a small outflow tract. The likelihood of this complication may be reduced by appropriate modification of surgical technique.