保留后瓣及瓣下结构二尖瓣替换术13例报告

保留后瓣及瓣下结构二尖瓣替换术１３例报告陈达琨，谢辉我院从１９９１年元月～１９９３年４月，进行保留后瓣及瓣下结构的二尖瓣替换术１３例。男５例，女１０例，年龄１７～４７岁。术前诊断：风心二狭二闭１１例，二尖瓣脱垂２例，伴房颤３例。手术方法：常规休外循环...     

儿童瓣膜替换术

儿童心脏瓣膜疾病应尽量采用修复技术进行了治疗，但病变严重者，也应行瓣膜置换术。为此，作者总结１４岁以下儿童瓣膜替换术２７例的经验。其中二尖瓣替换１２例，三尖瓣替换１１例，主动脉瓣替换４例。有合并畸形者１６例（５９．３％），术前心功能Ⅲ、Ⅳ级２３例（８５％）。１３例同期修复心脏畸形。早期死亡３例（１１．１％），晚期死亡４例（１６．６％），再次换瓣２例。作者认为：对儿童换瓣应选择较大型号的机械瓣，对瓣环小的病例要改进缝合技术，机械瓣替换术后应用低强度抗凝治疗是安全可靠的。     

三瓣膜替换术中自体心包片加宽升主动脉及其瓣环2例

三瓣膜替换术中自体心包片加宽升主动脉及其瓣环２例王奇，朱朗标１９９２年２月和１９９４年５月，我们为２例风湿性心脏病联合瓣膜病变病人行二尖瓣、主动脉瓣及三尖瓣三瓣膜替换术的同时，用自体心包片加宽升主动脉及主动脉瓣环，取得良好效果。现报告如下：临床资料２...     

应用侧倾碟瓣单瓣替换90例

应用侧倾碟瓣单瓣替换９０例陈锁成，孙斌，王康荣，钱成，丁国文１９８１年２月至１９９３年１２月，我们应用侧倾碟瓣行心脏单瓣替换术９０例。其中二尖瓣替换术（ＭＶＲ）８４例，主动脉瓣替换术（ＡＷＲ）６例。现就治疗体会报告如下：资料与方法本组男３２例，女５８...     

三种岛状瓣用于手部矫形修复

三种岛状瓣用于手部矫形修复黄彦杰，孙思明，朱宗岭，朱大成，徐厅梅作者应用三种岛状瓣修复手部软组织缺损２３例，经２年以上复查全部成功。临床资料：本组男１３例，女１０例，年龄９～４３岁。病因有外伤１１例，烧烫伤７例，先天畸形５例。其中采用挠侧岛状瓣修复１...     

40例双瓣替换术体外循环分析

本文报告了４０例双瓣替换术体外循环及心肌保护方法。本组病例包括３８例主动脉瓣和二尖瓣替换术，２例主动脉瓣、二失瓣和冠状动脉搭桥术。术前心功能Ⅱ级６例，Ⅲ级２８例，Ⅳ级６例。升主动脉阻断时间平均９６分钟，自动复跳１０例，住院死亡２例，住院死亡率５％。并讨论了双瓣替换术心肌保护的有关问题。     

重症心脏瓣膜替换术35例报告

重症心脏瓣膜替换术３５例，占同期心瓣膜直视手术的５０％。其中双瓣膜替换（ＤＶＲ）１６例，巨大心脏行ＷＶＲ１３例，ＡＶＲ２例，二尖瓣闭式分离术后再次换瓣３例，急症换瓣２例。死亡５例，死亡率１４．３％。本文就重症心瓣膜替换术围术期处理及如何加强心肌保护等问题进行了讨论。     

生物瓣衰坏病人的再次瓣膜替换经验

总结２０例生物瓣衰坏病人的再次换瓣经验。第一次替换生物瓣时１９例为单纯二尖瓣替换，１例为二尖瓣、主动脉瓣双瓣替换。生物瓣在体内工作６～１２４年。二次手术前心功能ＩＩ级１例，ＩＩ级１２例，ＩＶ级７例。手术共替换２２枚机械瓣。手术死亡２例。作者指出对生物瓣替换术后的病人要定期复查，发现瓣膜有运动异常应及时再次手术换瓣，对心功能差的病人应作积极术前准备。分离心包内粘连不宜过多，提倡采用常温体外循环，持续温血灌注保护心肌；术后支持呼吸、循环功能，延长辅助呼吸时间也是十分必要的。     

先天性二尖瓣关闭不全的外科治疗

本组１５４例先天性二尖瓣关闭不全患者中，单纯关闭不全者２３例，有合并畸形者１３１例。二尖瓣修复手术１４４例，换瓣１０例。修复手术包括交界折叠术１２５例；瓣膜裂隙缝合术１１例；大瓣孔洞修补术１例；小瓣部分切除缝合加瓣环成形术３例；大瓣腱索延长缩短术４例。全组早、晚期死亡各１例，修复不满意再手术换瓣者２例，生物瓣衰竭再手术者１例。作者认为，术前彩超检查对本病的诊断是简捷有效的方法。手术以瓣膜修复为主，根据不同病变采用各种修复方法。本组修复手术未用人工环，效果满意。对于病变严重，经修复不满意者需行二尖瓣替换。儿童换瓣选用稍大型号的双叶瓣为宜     

机械瓣血栓性故障再换瓣2例

机械瓣血栓性故障再换瓣２例黄达德，陈文广，张从新，杨爱莲，林一平，吕德雄例１女，２５岁。１９９１年应用２７号上海侧倾碟瓣行二尖瓣替换术，术后每日华法林２ｍｇ抗凝治疗，但未能按时服药。３年后出现活动后心慌、气促，咳血痰。查体：Ｔ３７．８℃，Ｐ１２８次／...     

"缘对缘"瓣膜成形术在先天性心脏病合并重度三尖瓣关闭不全中的应用

目的 总结运用"缘对缘"成形技术治疗先天性心脏病病人的重度三尖瓣关闭不全的效果.方法 2001年4月至2010年3月,对14例先大性心脏病合并重度三尖瓣关闭不全病人采用常规三尖瓣瓣环成形和"缘对缘"技术行三尖瓣成形.年龄7～62岁,平均(31.2±16.1)岁.先大性心脏畸形包括继发孔房间隔缺损6例,房室管畸形5例,继发孔房间隔缺损合并二尖瓣关闭不全2例,三房心1例.结果 14例出院时均无不适,无住院死亡及术后并发症.术后超声心动图检查示三尖瓣关闭不全无或微量11例,轻度3例.随访3～97个月,平均(51.6±26.8)个月.随访时超声心动图检查示均无三尖瓣狭窄,三尖瓣关闭不全无或微量5例,轻度8例,中度1例.结论 "缘对缘"成形技术纠治先天性心脏病合并重度三尖瓣关闭不全简单、有效.     

膨体聚四氟乙烯缝线替换心瓣膜腱索

目的：验证膨体聚四氟乙烯缝线在心脏瓣膜成形术中行腱索替换的效果。方法：１９９１年６月至１９９８年３月在心瓣膜成形术中采用膨体聚四氟乙烯缝线进行人工腱索替换２３例：替换二尖瓣腱索２８支,三尖瓣腱索１支。结果：病人人武部康复出院。其中１７例随访２￣７８个月,平均１８．５个月。彩色Ｂ超复查显示瓣膜关闭不全完全矫正者６例,仍残存极为以并关闭不全者３例,轻并关闭不全７例,术后仍有中并反流１例,系人工腱索过短     

Utilization of the Edge-to-Edge Valve Plasty Technique to Correct Severe Tricuspid Regurgitation in Patients with Congenital Heart Disease

Abstract   Objective: Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using the edge-to-edge valve plasty technique to correct severe tricuspid regurgitation in patients with congenital heart disease. Methods: From December 2002 to August 2007, severe tricuspid regurgitation was corrected with a flexible band annuloplasty and edge-to-edge valve plasty technique in nine patients with congenital heart disease. The age ranged from 7 to 62 years (average 24.4 years). Congenital cardiac anomalies included atrioventricular canal in five cases, secundum atrial septal defect in three cases, and cor triatriatum in one case. Results: No hospital death or postoperative morbidity occurred. No or trivial tricuspid regurgitation was present in six cases and mild tricuspid regurgitation in three cases at discharge. The follow-up ranged from 12 months to 70 months (average 39.3 months). No tricuspid stenosis was found. No to mild tricuspid regurgitation was present in eight cases, and moderate tricuspid regurgitation in one case at the latest follow-up. Conclusions: Edge-to-edge valve plasty is an easy, effective, and acceptable additional procedure to correct severe tricuspid regurgitation in patients with congenital heart disease.     

三尖瓣置换术后早期及晚期疗效

目的　总结三尖瓣置换术后早期及晚期疗效 ,并分析与早期病死率可能有关的危险因素。方法　行三尖瓣置换术 2 3例病人中男 11例 ,女 12例 ;年龄 12～ 5 6岁 ,平均 2 7岁。其中三尖瓣下移畸形17例、先天性三尖瓣发育不全 3例、风湿性病变 2例、感染性心内膜炎 1例。术前心功能II级 3例、III级13例 ,IV级 7例。结果　本组死亡 3例 ,早期病死率 13%。平均随访时间 80个月 (5～ 130个月 ) ,随访率95 %。晚期死亡 1例 (5 2 % )。1例于术后 86个月时因生物瓣失功再次行三尖瓣置换 ;1例右房血栓。术后生存者心功能I～II级 15例 ,III级 3例。多因素分析显示 ,心功能IV级 (P =0 0 2 )、严重腹水 (P =0 0 0 1)及置换机械瓣 (P =0 0 13)与术后早期病死率有显著相关。结论　三尖瓣置换术后早期及晚期效果良好。术前心功能IV级、严重腹水以及置换机械瓣对术后早期病死率有明显影响     

Repair of Ebstein's anomaly in the symptomatic neonate: an evolution of technique with 7-year follow-up

BACKGROUND: Ebstein's anomaly in the severely symptomatic neonate is usually fatal. Until recently, successful repair has not been reported and various palliative operations have been associated with prohibitive mortality. Recently, we published our initial results with biventricular repair in 3 severely symptomatic neonates. We now update our experience with emphasis on the evolution of our surgical technique and the medium-term follow-up of these patients. METHODS: Since 1994, 8 severely symptomatic neonates and young infants underwent biventricular repair by one surgeon. Six had Ebstein's anomaly and 2 had physiologically similar pathology with severe tricuspid valve dysplasia, cyanosis, and gross cardiomegaly. One Ebstein patient (2 months old) had undergone a Starnes operation elsewhere. Weight of the patients at operation ranged from 2.1 to 6.4 kg (mean 2.7 kg). Five patients had either anatomical (n = 3) or functional (n = 2) pulmonary atresia. Severe (4/4) tricuspid regurgitation was present in all except 1 (Starnes operation), and cardiothoracic ratio exceeded 0.85 in all patients. Echocardiography severity scores were >1.5 in 6 (grade 4/4) and 1.3 in 1 (grade 3/4). Repair consisted of tricuspid valve repair, reduction atrioplasty, relief of right ventricular outflow tract obstruction, partial closure of atrial septal defect, and correction of all associated cardiac defects. Technique of tricuspid valve repair evolved over time: 3 had Danielson-type repairs, 3 had DeVega-type repairs, and 2 had complex repairs. RESULTS: One patient died in hospital: a 2.1 kg patient with tricuspid dysplasia, anatomical pulmonary atresia, and hypoplastic pulmonary arteries. The other 7 patients are all in functional class I and in sinus rhythm. Although 3 patients had symptomatic tachyarrhythmias before surgery, no child has experienced SVT after discharge. At recent echocardiography 4 patients had mild tricuspid regurgitation, and 2 had mild-moderate (2/4) tricuspid regurgitation. Three patients are now 7 years old, 2 are almost 2 years old, and the remaining 2 patients are 1 year old. CONCLUSIONS: Surgical repair of the severely symptomatic neonate with Ebstein's anomaly is feasible and safe. The repair appears durable and with good medium-term outcome.     

主动脉窦瘤破裂的外科治疗及远期疗效

目的 总结主动脉窦瘤破裂的临床特点及外科疗效,讨论对合并感染性心内膜炎及主动脉瓣关闭不全患者的处理.方法 回顾性分析1997年9月至2007年9月43例主动脉窦瘤破裂患者的临床资料.其中男性32例,女性11例;年龄11～50岁,平均年龄(29.0±11.5)岁.破口源于右冠状动脉窦34例,无冠状动脉窦9例.破入有心室30例,右心房8例,右心室及右心房3例,破人室间隔2例.合并室间隔缺损26例,主动脉瓣关闭不全15例,感染性心内膜炎8例,三尖瓣反流6例,房间隔缺损4例,二尖瓣反流2例,动脉导管未闭2例,肺动脉赘牛物1例.全部患者于心肺转流下行窦瘤修补及合并畸形矫治术.结果 无围手术期死亡.并发症5例,包括急性左心功能衰竭3例,Ⅲ度房室传导阻滞2例.随访6～120个月,平均(68.0±17.7)个月;2例分别于术后第6、8年行主动脉瓣置换术,2例进展为Ⅱ级主动脉瓣父闭小全.结论 主动脉窦瘤破裂外科治疗可获得满意效果.对合并主动脉瓣关闭小全及感染性心内膜炎的患者应早期手术,积极防治术后并发症并长期随访.     

Repair of Ebstein’s anomaly in the symptomatic neonate: an evolution of technique with 7-year follow-up

Background. Ebstein’s anomaly in the severely symptomatic neonate is usually fatal. Until recently, successful repair has not been reported and various palliative operations have been associated with prohibitive mortality. Recently, we published our initial results with biventricular repair in 3 severely symptomatic neonates. We now update our experience with emphasis on the evolution of our surgical technique and the medium-term follow-up of these patients.

Methods. Since 1994, 8 severely symptomatic neonates and young infants underwent biventricular repair by one surgeon. Six had Ebstein’s anomaly and 2 had physiologically similar pathology with severe tricuspid valve dysplasia, cyanosis, and gross cardiomegaly. One Ebstein patient (2 months old) had undergone a Starnes operation elsewhere. Weight of the patients at operation ranged from 2.1 to 6.4 kg (mean 2.7 kg). Five patients had either anatomical (n = 3) or functional (n = 2) pulmonary atresia. Severe (4/4) tricuspid regurgitation was present in all except 1 (Starnes operation), and cardiothoracic ratio exceeded 0.85 in all patients. Echocardiography severity scores were >1.5 in 6 (grade 4/4) and 1.3 in 1 (grade 3/4). Repair consisted of tricuspid valve repair, reduction atrioplasty, relief of right ventricular outflow tract obstruction, partial closure of atrial septal defect, and correction of all associated cardiac defects. Technique of tricuspid valve repair evolved over time: 3 had Danielson-type repairs, 3 had DeVega-type repairs, and 2 had complex repairs.

Results. One patient died in hospital: a 2.1 kg patient with tricuspid dysplasia, anatomical pulmonary atresia, and hypoplastic pulmonary arteries. The other 7 patients are all in functional class I and in sinus rhythm. Although 3 patients had symptomatic tachyarrhythmias before surgery, no child has experienced SVT after discharge. At recent echocardiography 4 patients had mild tricuspid regurgitation, and 2 had mild-moderate (2/4) tricuspid regurgitation. Three patients are now 7 years old, 2 are almost 2 years old, and the remaining 2 patients are 1 year old.

Conclusions. Surgical repair of the severely symptomatic neonate with Ebstein’s anomaly is feasible and safe. The repair appears durable and with good medium-term outcome.     

二尖瓣置换术后远期功能性三尖瓣关闭不全的外科治疗

目的：报告二尖瓣置换（ＭＶＲ）术后远期三尖瓣关闭不全（ＴＲ）外科治疗的结果及作用,方法：３７例ＭＶＲ术后中重度ＩＲ病人,其中人工二尖瓣为生物瓣者１３,机械瓣２４例,有１１例行内科保守治疗,２６例行外科手术治疗,手术类型,ＭＶＲ加三尖瓣置换２例,ＭＶＲ加三法瓣成形１１例,三尖瓣置换３例,三尖瓣成型１０例,三尖瓣成形术包括改良Ｋay形成形１２例,改良ＤeVega成形术７例,加成形环的三尖瓣成形术２例,结果：１１例内科治疗者,７个月－７．５年后７６例死亡,病死率为５４．５％,26例手术治疗者,术后早期病死２例,病死率为７．７％,随访个月－１０．５年,晚期死亡例,仍中度ＴＲ２例,结论：ＭＶＲ术后远期ＴＲ的产生与不可逆的左心损害或（和）严重肺动脉高压有关,对重度ＴＲ伴有临床症状、左心功能基本正常者,行三尖瓣成形或三尖瓣置换术可取得良好的效果。     

De Vega tricuspid annuloplasty for tricuspid regurgitation in children

BACKGROUND: Significant tricuspid valve regurgitation (TR) occurs with other congenital heart defects, typically after repair of right-sided obstructive lesions. Since 1991, we applied the De Vega tricuspid annuloplasty technique for TR in children. METHODS: Forty-one children, aged 5 months to 22.7 years (mean, 9.9 years) underwent 42 De Vega tricuspid annuloplasties for moderate or severe TR during correction of other heart defects. One child had a De Vega during primary ventricular septal defect repair. The remaining patients had prior repair of tetralogy of Fallot or pulmonary atresia, or both (19 patients), double-outlet right ventricle (6 patients), pulmonary stenosis (4 patients), pulmonary atresia and intact ventricular septum (3 patients), complete atrioventricular septal defect (3 patients), and other diagnoses (6 patients). At the time of the De Vega, 37 patients (88%) had pulmonary valve replacement or right ventricular to pulmonary artery conduit replacement. Other procedures included aortic or mitral repair or replacement (6 patients), atrial septal defect and ventricular septal defect closure (5 patients), pulmonary arterioplasty (6 patients), and tracheoplasty (1 patient). RESULTS: There were no deaths at follow-up of 3.4 +/- 2.1 years; 1 child required cardiac transplantation 17 months postoperatively. Early postrepair echocardiography quantified TR as absent or mild (34 patients; 81%), mild-to-moderate (4 patients), moderate (3 patients), and severe (1 patient). The most recent echocardiogram showed moderate TR in 11 patients and severe TR in 2 patients (both with recurrent right ventricular hypertension). One child required tricuspid valve replacement 3 years later and 1 child had redo De Vega at the time of conduit re-replacement. No other child has symptomatic TR, significant tricuspid stenosis, or De Vega-related pacemaker implantation. CONCLUSIONS: The De Vega tricuspid annuloplasty safely provides excellent relief of TR, usually in children undergoing pulmonary valve replacement or conduit replacement. Although echocardiographic TR tends to increase with time (especially with right ventricular hypertension), it rarely requires reintervention or causes symptoms.     

Posterior annular plication: tricuspid valve repair in Ebstein's anomaly

BACKGROUND: Nonneonatal Ebstein's anomaly is a rare congenital anomaly for which numerous operative techniques have been described to repair the aberrant tricuspid valve, exclude the atrialized right ventricle, and address right heart dysfunction. We reviewed short-term outcomes in surgical patients treated by a simplified operative technique. METHODS: Our operative approach to Ebstein's anomaly is approximation of the anteroposterior commissure to the remnant septal leaflet with closure of the cul-de-sac longitudinally. Plication of the atrialized right ventricle (1 patient) and a bidirectional cavopulmonary connection (2 patients) were performed only if necessary. All patients were followed postoperatively by their cardiac surgeon and cardiologist. RESULTS: Seven patients with a mean age of 39 years (range, 3.6 to 63.8 years) underwent repair. Preoperatively all patients had 4+ tricuspid valve regurgitation and were New York Heart Association class III. Mean postoperative hospital stay was 7 +/- 2 days (range, 4 to 11 days). Mean follow-up is 42 +/- 18 months (range, 7 to 58 months). At last follow-up 5 patients are New York Heart Association class I and average tricuspid valve regurgitation is mild. CONCLUSIONS: Plication of the posterior annulus without plication of the atrialized right ventricle, resiting the tricuspid valve, or performing prophylactic cavopulmonary connection appears to be a reasonable operative approach to nonneonatal Ebstein's anomaly. Long-term follow-up of this cohort is necessary to determine the durability of such a surgical approach.