体外循环心内直视术后出血早期诊断和治疗

我院自１９９５年８月～１９９９年１２月，共行体外循环心内直视手术 ４５例，其中 ９例（２０％）心包纵隔引流量多；４例经保守治疗治愈；５例经２次开胸止血治愈，现报告如下．１临床资料 本组病例男５例，女４例，年龄３～４３岁，平均３２岁．风心瓣膜病３例；先天心６例；其中三联症１例，房缺１例，室缺３例．室缺合并肺动脉瓣狭窄１例．风心病病人均行瓣膜替换术，先心病行相应畸形矫治术．体外循环结束后鱼精蛋白中和肝素１～１．５：１，以ＡＣＴ恢复至术前水平，术野出现凝血块为拮抗完全的标准．２结果 全组病人手术经过顺利，…     

生物瓣膜置换三尖瓣13例临床观察

目的探讨应用生物瓣膜置换三尖瓣的手术治疗效果。方法回顾分析2006年1月～2009年2月间我院13例三尖瓣置换患者的临床资料，其中风湿性心脏联合瓣膜病5例，Ebstein畸形4例，先天性三尖瓣发育不良4例，均接受了生物瓣膜置换三尖瓣手术。结果无死亡病例，患者术后服用华法林3～6个月，随访2个月～3年3个月，瓣膜功能良好，心功能均得到不同程度的改善，未发现瓣周漏、感染性心内膜炎和血栓、出血等并发症。结论应用生物瓣膜进行三尖瓣置换，对于无法成形或既往成形失败的患者，是较为理想的治疗方法。     

佳木斯地区低出生体重儿684例临床分析及随访

本文对我院１９８５年１月－１９９１年１月分娩的活产婴１５５６４人中低出生体重儿６８４例，发生率为４．４％，其中５２例为早产儿，死亡率为８．３３％。分析结论是孕周越小死亡率越高，体重越小死亡率越高。本组随访率为４７．８８％，智能检查ＤＤＳＴ可疑２０例，均以大的动作能及言语发育迟缓，平均身高，体重，头围接近９市城区男女儿童，略低于北京市儿童保健所１９８６年制定的正常发育的指标。     

儿童心脏瓣膜置换手术技巧及效果

目的 总结1999年9月至2006年9月14例儿童心脏瓣膜置换术的经验。探讨儿童瓣膜置换的手术指征、辩膜选择、手术技术和术后抗凝治疗等问题。方法 全组14例中10例为先天性心脏瓣膜病变，3例风湿性病变，1例先天性室间隔缺损致心内膜炎、主动脉瓣膜菌栓。在中低温体外循环下手术，二尖瓣置换7例，主动脉瓣置换6例，二尖瓣置换＋主动脉瓣置换1例。均采用机械瓣。若合并其它先天性心脏畸形或三尖瓣关闭不全，同期矫治。术后常规应用华法林抗凝。结果 本组手术死亡1倒，12例心功能恢复至Ⅰ级，1例心功能Ⅱ级。发生1例感染性心内膜炎，治愈。均坚持采用华法林抗凝，无血栓栓塞及抗凝相关并发症发生，辩膜功能良好。结论 儿童心脏瓣膜置换术采用机械瓣效果较好；应用低强度的华法林进行抗凝治疗安全可靠。     

SJM瓣膜闭锁音音频特性的时间频率分析

ＳＪＭ瓣膜闭锁音音频特性的时间频率分析［日］／藤田康雄…／／人工脏器．－１９９４，２３（１）．－１５１近年来为了早期发现以血栓为首的辩膜机能异常及血栓栓塞症的发生，尝试对人工瓣膜的闭锁音的周期进行分析，其意义还没有确立。作者应用Ｗｉｇｎｅｒ－Ｖｉｌｌ...     

机械瓣血栓形成与国际标准化比率的调控

瓣膜血栓形成、血栓栓塞及抗凝有关的出血是机械瓣替换天然心脏瓣膜后最常见和最严重的并发症，也是术后的主要死亡原因。其发生涉及瓣膜本身的血流动力学特性和材料特性、患罹患的疾病状态，以及个体抗凝强度的控制水平等多个方面。因此，对不同个体、不同类型的人造心脏瓣膜，维持不同的抗凝强度，是预防瓣膜相关并发症的最重要措施。     

儿童心脏瓣膜置换手术技巧及效果

目的总结14例儿童心脏瓣膜置换术的经验,探讨儿童瓣膜置换的手术指征、瓣膜选择、手术技术和术后抗凝治疗等问题。方法全组14例中10例为先天性心脏瓣膜病变,3例风湿性病变,1例先天性室间隔缺损致心内膜炎、主动脉瓣膜菌栓。在中低温体外循环下手术,二尖瓣置换7例,主动脉瓣置换6例,二尖瓣置换 主动脉瓣置换1例。均采用机械瓣。若合并其它先天性心脏畸形或三尖瓣关闭不全,同期矫治。术后常规应用华法林抗凝。结果本组手术死亡1例,12例心功能恢复至I级,1例心功能II级。发生1例感染性心内膜炎,治愈。均坚持采用华法林抗凝,无血栓栓塞及抗凝相关并发症发生,瓣膜功能良好。结论儿童心脏瓣膜置换术采用机械瓣效果较好;应用低强度的华法林进行抗凝治疗安全可靠。     

上海为一患者成功替换4个心脏瓣膜

上海第二军医大学附属长海医院，最近成功地为一名严重感染性心内膜炎患者施行了４个心脏瓣膜替换手术。据文献记载，一次手术同时替换４个病变的心脏瓣膜，在我国尚属首次，在世界心脏外科领域为第二例。江苏太仓４７岁的农民钱惠明，经长海医院确诊为４个心脏瓣膜，即主动瓣、二尖瓣、三尖瓣、肺动脉瓣均有大量细菌侵袭，生成赘生物；这意味着患者心脏所有的４个控制血流的“阀门”已严重受损，引起心脏关闭不全，导致心功能严重下降，贫血、肝肾功能衰退，持续高烧，生命垂危。在进行药物治疗后，患者的身体状况获得短期改善。我国著名心…     

心脏瓣膜置换手术多功能器械的研制及其临床应用

１９９５ 年我 们采用钛材和１ Ｃｒ １８ Ｎｉ ９ Ｔｉ 丝 研制的心脏瓣 膜置换手术多功 能器械由胸 骨牵开 器、板 式拉钩６ 个，瓣膜 缝线固定 簧组成。至 １９９８ 年 ３ 月，经 ８０ 家医院 在主动脉 瓣替换术 、二尖瓣 替换术 、三尖瓣替换术中 广泛地应 用，术 野上 有二 条长 １３０ ｍ ｍ 的０ ．２ ～０ ．３ ｍ ｍ 的簧 间隙， 使 缝主 动脉瓣 、二尖 瓣、三尖 瓣的 每根缝 线都可 选最 佳位置 固定； 四点牵 开胸骨 ，分散 了对牵 开胸骨 所承 受压 力；６ 个不 同尺寸的可塑 性拉钩将切口充 分暴露。解 决了 三十年 来用 蚊式 钳夹 缝线 造成 的难 以分 开，固定松紧不 均问题，二点牵开 胸骨造成骨折 ，及切口暴露不清 等难题。     

闭合性三踝骨折45例临床治疗体会

从９３年１月至９７年１月共收治闭合性三踝骨折４５例，其中手术３６例，临床随访６个月至３年，平均随访１．９年。所有病例均获骨性愈合，参照齐氏疗效判定标准，优良率８８．９％。作者认为三踝骨折应尽早手术治疗。对此型骨折的具体手术操作方法及内固定问题进行了介绍和讨论。     

Mechanical circulatory assistance in the management of patients in coronary care unit

Mechanical circulatory assistance was attempted in 73 patients at our coronary care unit from January 1, 1983, to January 1, 1987. Of these, 62 were men and 11 were women. The intra-aortic balloon pump (IABP) was successfully inserted by percutaneous femoral puncture in all cases. Indications for an IABP included: acute infarction and haemodynamic deterioration (23 cases), refractory congestive heart failure (2 cases), hypotension, ST-T changes and chest pain complicating coronarography or coronary angioplasty procedures (16 cases), unstable angina pectoris resistent to medical therapy, treated by coronary angioplasty (16 cases) and preoperative haemodynamic coverage (16 cases). The overall major complication rate of IABP was 1.5%. Our experience supports aggressive management of cardiogenic shock, i.e. early angioplasty or cardiac surgery, which considerably influences the functional status and the long-term survival rate (7/9 cases) over medical therapy combined with IABP (2 of the 14 patients are alive). The IABP was also effective in managing other high-risk patients when it was combined with some form of definitive cardioprotective mechanical correction, i.e. aneurysmectomy, valve replacement, coronary recanalization procedure. When the counterpulsation was used prophylactically, no interventional myocardial infarctions or deaths occurred; the survival rate was 27/32 patients for a 22 month average follow-up. It is suggested that the clinical results and late survival were improved by use of IABP in selected patients undergoing coronary angioplasty or open-heart surgery.     

Results of valve replacement surgery with mechanical prostheses

The clinical study is reported of the results of heart valve replacement surgery with a new pyrolytic carbon tilting disc prosthesis manufactured in Italy. From March 1977 to January 1981, at the "De Gasperis" Cardiosurgery Center, this prosthesis has been implanted in 644 patients: 283 for mitral valve replacement, 240 for aortic valve replacement, and 121 for the replacement of both mitral and aortic valves. To have a sufficiently long period of post-surgery follow-up, we considered the results of 207 patients (124 cases of isolated mitral valve replacement and 83 cases of isolated aortic valve replacement), who underwent surgery consecutively from March 1977 to December 1979. The hospital mortality was 10.5% for mitral valve replacement and 4.8% for aortic valve replacement. All patients who were discharged from hospital, except 2, were subjected to clinical, electrocardiographic, phonocardiographic, echocardiographic and radiological checks. The average follow-up period was approximately 20 months: clinical results were satisfactory. The probability of survival, expressed by actuarial curve, was, three years after surgery, 94% for patients who underwent mitral valve replacement and 97.5% for those who underwent aortic valve replacement. The probability of embolism was, three years after surgery, 8.5% for patients with mitral replaced and 5% for aortic. Even if further confirmations are needed the mortality rate and the probability of embolism related to this new prosthesis, are lower, over the same period of follow-up, than that found in the groups of patients who underwent valve replacement surgery, at the same Center, with Starr-Edwards and Bj?rk-Shiley prostheses. The phonocardiographic and echocardiographic characteristics of this new prosthesis were also investigated.     

心脏人工机械瓣相关并发症外科治疗初步经验

目的　总结 15例心脏人工机械瓣相关并发症外科治疗初步经验。方法　本组 15例患者中 ,男 7例 ,女 8例 ,年龄 315 9岁 ,平均 (4 5 .5± 8.0 )岁。术前均明确诊断 ,人工机械瓣心内膜炎 4例 ,单纯主动脉瓣周漏 4例 ,单纯二尖瓣周漏 4例 ,单纯主动脉瓣并二尖瓣周漏 2例 ,二尖瓣栓塞 1例。肺水肿 10例 ,充血性心力衰竭 6例。再次手术距首次手术时间间隔 1个月至 72个月 ,平均 (2 1.9± 18.2 )个月。本组在全麻中度低温体外循环下行再次主动脉瓣替换术 4例 ,再次二尖瓣替换术 2例 ,主动脉瓣周漏修补术 2例 ,二尖瓣周漏修补术 5例 ,主动脉瓣和二尖瓣周漏修补术 2例。同期手术包括主动脉右心室交通残余漏修补术 1例 ,三尖瓣成形术 4例 ,主动脉瓣替换术 1例 ,冠状动脉旁路移植术 1例。结果　手术死亡 5例 (33.3% )。术后低心排、多脏器功能衰竭 (3例 )为死亡主要原因。 1例为劈胸骨时损伤主动脉大出血 ,术后深昏迷死亡 ,中毒性休克死亡 1例。存活 10例 ,随访 ,死亡 1例为再次主动脉瓣替换术后半年瓣膜栓塞 ,余 9例心功能明显改善。结论　人工机械瓣膜病外科治疗值得 ,但手术危险性较高     

Twenty-two year experience with the omniscience prosthetic heart valve

This study was designed to evaluate the long-term clinical results of the Omniscience tilting disc valve. Omniscience valves were implanted in 51 patients (mean age, 50 +/- 10 years); 18 had aortic valve, 24 had mitral valve, and 9 had both aortic and mitral valve replacements. Oral warfarin potassium and dipyridamole were prescribed as our anticoagulant therapy. Preoperatively, 42 patients were in New York Heart Association class III or IV, and 23 of 25 surviving patients were in class I or II after operation. There were 2 (3.9%) early deaths and 23 late deaths (3.5 +/- 0.7% per patient-year). Cardiac related mortality including congestive heart failure, sudden death, and thromboembolism, and hemorrhagic complications were seen in 16 patients. Overall survival at 10, 15, and 20 years was 77 +/- 6%, 62 +/- 7%, and 46 +/- 7%, respectively. Thromboembolic complications were seen in 5 patients, for a rate of 0.8 +/- 0.3% per patient-year; similarly, hemorrhagic complications were also seen in 5 patients. Nonstructural prosthetic valve dysfunction was seen in 4 patients, for a rate of 0.6 +/- 0.3% per patient-year, and sudden death was seen in 2, a rate of 0.3 +/- 0.2% per patient-year. The Omniscience prosthesis demonstrated excellent postoperative clinical status with low rates of valve related complications.     

Comparison of long-term results between Hancock porcine bioprosthesis and Carpentier-Edwards pericardial bioprosthesis in the aortic and the mitral positions

The aim of this study was to compare the long-term results with the Carpentier-Edwards pericardial bioprosthesis, a second-generation bioprosthesis, and the Hancock porcine valve in the aortic and mitral position. Long-term results of isolated valve replacement with the Carpentier-Edwards pericardial bioprosthesis (73 valves in the aortic position and 73 valves in the mitral position) were compared with those with the Hancock porcine bioprosthesis (41 valves in the aortic and 124 valves in the mitral position). In the aortic position, the mean follow-up period was 8.2±4.0 years with the Carpentier-Edwards pericardial bioprosthesis and 9.9±4.4 years with the Hancock porcine bioprosthesis. In the mitral position, the mean follow-up period was 7.5±4.3 years with the Carpentier-Edwards pericardial bioprosthesis and 10.0±5.3 years with the Hancock porcine bioprosthesis. The results showed that the mean age at implantation was significantly higher in patients with a Carpentier-Edwards pericardial bioprosthesis (58±13 years in the aortic and 51±15 years in the mitral) than in those with a Hancock bioprosthesis (42±13 years in the aortic and 45±10 years in the mitral). In the aortic position, actuarial freedom from structural deterioration of the Carpentier-Edwards pericardial bioprosthesis was significantly better (85±6% at 13 years) than that with the Hancock bioprosthesis (40±10%,P<0.02). In the mitral position, actuarial freedom from structural deterioration of the Carpentier-Edwards pericardial bioprosthesis was similar to that with the Hancock bioprosthesis (32±9% and 44±6% at 13 years, respectively). It is concluded that the durability of the Carpentier-Edwards pericardial bioprosthesis in the aortic position was satisfactory in the elderly patients. In the mitral position, the superior durability of the Carpentier-Edwards pericardial bioprosthesis against the Hancock bioprosthesis failed to be proved.     

The CarboMedics prosthetic heart valve: experience with 180 implants

At Jichi Medical School Hospital, three types of mechanical prosthetic valves (CarboMedics, Omnicarbon, Bicarbon) were used without randomization from 1991 to 2000. A retrospective study of valve replacements done between June 1991 and November 2000 utilizing 180 CarboMedics valves in 145 patients who had not previously undergone prosthetic valve replacement or aortic root and/or arch replacement was conducted to evaluate midterm patient outcomes to assess the future continuous use of CarboMedics valves. Women made up 47.6% of the patients and the mean age was 57.5 years (range 12–80 years). Preoperative New York Heart Association functional class was III or IV in 92.4% (134/145) of patients. Mean follow-up of 4.5 years (range 0–10.0 years) was 95.9% complete, with a total of 628 patient-years (PY). Early (within 30 postoperative days) mortality was 5.5% (8 of 145): 3 from hemorrhage, 3 from nonvalve-related heart failure, 1 from infection, and 1 from arrhythmia. There were 16 late deaths (2.54%/PY): 1 from hemorrhage, 4 from unknown causes/sudden death, 4 from nonvalve-related heart failure, and 7 from other noncardiac causes. A total of 121 patients (83.0%) were alive at the last follow-up, done in November 2000. The linearized death rate was 3.82%/year (including 1.11%/year for valve-related deaths). Linearized death rates from various causes were: bleeding, 0.96%/year; thromboembolism, 1.11%/year; thrombosis, 0.39%/year; perivalvular leak, 0.96%/year; endocarditis, 0%/year; hemolysis, 0%/year; and reoperation, 0.63%/year. No structural valve failure was observed. Comparative early mortality rates of valve replacement without aortic root replacement or arch replacement, excluding repeat valve replacement operations, in our institute, were 3.5% (12/307) for all valve types used contemporaneously, 2.6% (2/76) for Omnicarbon valves, and 2.3% (2/86) for Bicarbon valves. Although the CarboMedics valve had a rather high mortality rate of 5.5% (8/145) compared with the total early mortality rate of 3.5%, the low incidence of valve-related complications might support the continued use of the CarboMedics valve for valve replacement.     

Isolated pulmonary valve replacement: analysis of 27 years of experience

The aim of this study was to investigate the longterm results of isolated pulmonary valve replacement using xenobioprostheses or mechanical valves. Twenty-four cases of isolated pulmonary valve replacement carried out at Kyushu University Hospital between 1977 and 2004 were reviewed. Those undergoing Rastelli's operation were excluded from this study. Bioprostheses were used in 18 patients and mechanical valves in 6. There were no operative deaths. Two patients with mechanical valves needed repeat pulmonary valve replacement due to thrombosed valves. The patients with bioprostheses had no need of repeat replacement postoperatively. The cardiothoracic ratio significantly improved from 60.3% preoperatively to 55.4% postoperatively (P < 0.05), and the New York Heart Association (NYHA) class significantly improved from 2.0 preoperatively to 1.1 postoperatively (P < 0.05). The actuarial survival rate at 15 years was 92.3%. The valve-related event-free ratio at 15 years was 85.7% in the bioprosthesis group and 66.7% in the mechanical valve group, with no significant difference. Isolated pulmonary valve replacement with bioprostheses or mechanical valves can be safely done and showed satisfactory long-term results. The mechanical valve group demonstrated a high ratio of thrombosed valves. A bioprosthesis is recommended for pulmonary valve replacement if a homograft is not available.     

Influence of pressure load on durability of pulmonic xenobioprostheses in young adults

The aim of this study was to investigate the effects of pressure load (pulmonary arterial pressure) on the long-term durability of second-generation xenobioprostheses in the pulmonary position in young adults. Thirteen patients survived pulmonary valve replacement for pulmonary regurgitation using the second-generation aortic porcine bioprosthesis at Sapporo Medical University School of Medicine between 1985 and 2009. The mean age at pulmonary valve replacement was 40.5 years, and the mean prosthetic valve size was 25.3 mm. Two patients developed structural valve deterioration 6 and 9 years, respectively, after pulmonary valve replacement. Both prosthetic valves with structural valve deterioration were subjected to long-term high levels of pressure load. No valve structural failure was observed in the remaining 11 patients who experience low-pressure load during a mean follow-up period of 11.9 years. The freedom from structural valve deterioration at 15 years was 75.8% for the overall population, but 100% for those with low-pressure load. Our findings suggest that the long-term durability of pulmonary-site bioprosthetic valves in young adult patients is promising but that pressure load might be a risk of the limited durability of the valve.     

Long-term experience with the Bjork-Shiley Monostrut tilting disc valve

The Bjork-Shiley Monostrut valve is tilting disc mechanical valve prosthesis. This study was designed to present the long-term outcome of our experience. One hundred and thirty-seven Bjork-Shiley Monostrut valves were implanted in 101 consecutive patients from November 1983 to February 1990. There were 60 male and 41 female with mean age of 34.5 yr at the time of operation. Fifty-nine patients underwent single valve replacement, 38 had double valve, and 4 had triple valve replacement. There were six in-hospital deaths (5.9%): three from cardiopulmonary bypass weaning failure and one each from septic shock, sudden cardiac arrest, and uncontrollable bleeding. Mean duration of follow-up was 181.2+/-76.2 months. Overall survival was 86.2% at 15 yr and 83.1% at 20 yr. Patients with mitral valve replacement had 93.5% and 90.2% cumulative survival at 10 and 15 yr, respectively, while patients with aortic valve replacement had 91.1% and 86.5% cumulative survival at 10 and 15 yr. Two groups had no significant difference in survival. Double valve replacement patients had 92.2% and 84.0% survival at 10 and 15 yr, respectively. There were no significant differences in survival between the single and double valve replacement groups. Freedom from thromboembolism was noted in: 97.8%, 97.8%, 96.4% and 87.8% at 5, 10, 15 and 20 yr, respectively. Absence of endocarditis was noted in 98.6% and 94.8% at 15 and 20 yr. Absence of reoperation was 92.5% at 20 yr. In conclusion, the Bjork-Shiley Monostrut valve is reliable, with a similar incidence of valve-related morbidity as in other mechanical valves.     

Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data

The epidemiology, and clinical and microbiological spectrum, of infective endocarditis (IE) in Greece was analysed in a prospective 4-year study in a tertiary hospital and a heart surgery centre in Athens. In total, 101 cases of IE (71 men, 30 women, aged 54.4 +/- 17.1 years) were studied, with a follow-up period of 3 months. Seventy-seven cases were definite and 24 possible; 59 involved native valves (native valve endocarditis; NVE), 31 prosthetic valves (prosthetic valve endocarditis; PVE), of which nine were early and 22 late, and 11 permanent pacemakers (pacemaker endocarditis; PME). There was a predominant involvement of aortic (48/101) and mitral (40/101) valves. Seven patients had rheumatic valvular disease, two had mitral valve prolapse, and eight had a previous history of IE. Thirteen and six patients had undergone dental and endoscopic procedures, respectively. In 13 patients, intravenous catheters were used within the 3 months before diagnosis of IE. There were three intravenous drug users among the patients. Staphylococcus aureus was the most important pathogen, isolated in 22% of cases, followed by viridans streptococci (19%) and coagulase-negative staphylococci (16%). Enterococcus spp. were responsible for 3%, HACEK group for 2%, and fungi for 6% of cases. Viridans streptococci were the leading cause of NVE (29%), Staphylococcus epidermidis of PVE (16%), and S. aureus of PME (54.5%). Six of 22 S. aureus and ten of 16 S. epidermidis isolates were methicillin-resistant. Surgical intervention, including total pacemaker removal, was performed in 51.5% of patients. Overall mortality was 16%, but was 29% with PVE, and was significantly higher with medical than with combined surgical and medical therapy (24.5% vs. 8%). Compared with previous studies, there were changing trends in the epidemiology, microbiology, treatment and prognosis of IE in Greece.