二尖瓣狭窄的外科治疗(附85例报告)

本文报告1972年8月至1987年8月我院85例风湿性二尖瓣(犭央)窄或伴有轻度关闭不全病人的外科手术疗效。80例行闭式扩张术,5例行直视扩张术。贵州地区病人体型较小,瓣膜损害较重。瓣口扩张2.8～3.5cm,较一般要求偏小。手术后近期疗效较好。     

Peripheral Seeding of Mycotic Aneurysms from an Infected Aortic Stent Graft

Aortic stent graft infection is rare and there are no reported cases of seeded peripheral mycotic aneurysms complicating this condition. We describe the case of a 54 year old man who developed a late stent graft infection at three years, resulting in the peripheral seeding of three mycotic aneurysms with two incidents of rupture. He was successfully treated with extra-anatomic bypass of the aorta and both surgical and endovascular repair of his peripherally seeded mycotic aneurysms.     

Prosthetic valve endocarditis due to candida albicans treated successfully with medical treatment alone

Prosthetic valve endocarditis (PVE) caused by Candida species is associated with high morbidity and mortality. A combination of surgical resection and antifungal drug therapy is the golden standard for treatment, yet surgical intervention is not possible in all cases of Candida PVE. We report a case of PVE due to Candida albicans cured by medical treatment alone. This case suggests that, in some instances, Candida PVE can be managed medically with antifungal therapy. Such a conservative approach should be applied with caution and necessitates very close follow-up on a long-term basis.     

缺血预处理对心脏瓣膜置换手术围术期甲状腺激素代谢的影响及临床意义

目的 :了解缺血预处理对心脏瓣膜置换手术围术期甲状腺激素 (TH)代谢的影响及临床意义。方法 :选取 16例风湿性心脏病 (风心病 )瓣膜置换手术患者 ,随机均分为实验组 (IP组 )及对照组 (C组 ) ,IP组采取缺血预处理方案 ,对照组不采取预处理 ,其余同IP组。分别于术前、转流中 (最低温 )、再灌注后 5min ,停机、术后 2 ,2 4 ,4 8h采取血样 ,测定血清总三磺甲状腺原氨酸 (TT3 )、总四碘甲状腺原氨酸 (TT4)、游离三磺甲状腺原氨酸 (FT3 )、游离四碘甲状腺原氨酸 (FT4)、促甲状腺激素 (TSH)浓度 ,组内各时点与术前 ,两组之间各时点进行配对比较。结果 :TT3 和FT3 水平在转流最低温时降至最低点 ,术后 4 8h仍低于术前 ,但IP组术后 2 4～ 4 8h二者水平明显高于对照组 (均P <0 .0 5 ) ,两组T4,FT4水平术后 2 4h已恢复术至前水平 ,各时点间无明显差异 ;TSH水平术后 4 8h两组均低于术前 ;IP组无严重并发症发生 ,对照组有 2例发生低心排。结论 :风心病瓣膜置换手术围术期呈现低T3 综合征 ;缺血预处理可以减轻瓣膜置换手术围术期低T3 综合征的严重程度 ,有利于心功能的恢复     

Ross术后中远期主动脉瓣反流的危险因素分析

Objective To analyze the risk factors of the postoperative mid- and long-term aortic valvular regurgitation after ROSS procedure(pulmanary valve homograft transplantation). Methods Between March 1998 and July 2007,47 patients[25male, 22 female, mean age (13.31±5.79) years, ronge 1-34 years] with aortic valvular disease underwent the Ross procedure at our insti tution. There were 6 patients suffering fron rheumatic heart disease and 41 patients suffering from congenital heart disease. The aver age aortic blood flow velocity was (4.67±3.47) m/s, the average pressure gradient across aortic valve (88.26±58.06)mm Hg, LVEDD (45.53 ±10.78) mm, EF 0.69±0.08. All the patients were followed up in out-patient departement by ultrasonic cardio gram. Multiple logistic regression analysis was performed to find out the risk factors of the postive aortic valvular regurgitation. Results There was no poetoperative death in hospital. The mean follow-up periods was (36.15±22.1) months, rasnge from 12 to 110 months and none long-dated death. Compared with the data recorded in hospital, the diamenters of the aortic sinus and aortic annu lus enlarged significantly, respectively from (26.16±5.10) mm to (32.37±6.84) tam and from (19.41 ～3.98) mm to (23.45± 5.86) mm. The average flow velocity d the homograft (new aortic valve) was(1.39±0.48) m/s, graclient pressure (8.17+6.16) mm Hg. Mild aortic regurgitstion was present in 5 patients (10.6%), moderate aortic tegmgitafion in 2 pmieats (4.3%) and aevere aortic regurgitation in 1 petient (2.1%). The rate of free from regurgitation was 82.9%. Multiple logistic analyses identified the per esence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years as the risk factors for posterative aortic regurg itation. Conclusion The Ross procedure is a safe and effective procedure with good clinical results in mid-and long-term follow-up. However, the presence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years preoperatively were identified as the risk factors for postoperative aortic regurgitation.     

Combined aortic and mitral valve repair in active infective endocarditis

We describe a case of successful combined repair of the aortic and mitral valves for an indication of active infective endocarditis involving both valves. Mitral valve repair was achieved by vegetation debridement, fixation of the anterior mitral commissure, resection and suturing of the posterior mitral leaflet, and posterior annuloplasty with autologous pericardium. Aortic valve repair was achieved by vegetectomy and commissural plication. Postoperative clinical course was without signs of recurrent infection, and echocardiogram demonstrated mitral valve competence with trivial aortic regurgitation. We concluded that simultaneous valve repair is a viable option in the context of active endocarditis.     

二尖瓣成形术临床应用542例及随访

目的回顾性总结542例二尖瓣成形术病人的手术疗效和20年随访结果。方法1985年至2006年，542例二尖瓣病变的病人接受二尖瓣成形术，男306例，女236例。474例随访1-240个月，平均（41．03±40．40）个月，随访率90．8％。结果手术死亡20例（3．7％），出院时病人心功能均为Ⅰ级或Ⅱ级。随访死亡20例，再次手术23例；7年、10年和15年生存率分别为91％、88％和70％；7年和10年二次手术免除率分别为94％和86％。结论二尖瓣成形治疗二尖瓣病变，死亡率低，远期效果好。     

黏膜瓣式食管胃吻合术抗反流的食管动力学研究

目的寻找一种实用有效的抗反流食管胃吻合术式。方法将食管癌和贲门癌患者464例随机分为黏膜瓣式食管胃吻合术组(A组,175例)、器械食管胃吻合术组(B组,151例)和单纯手工缝合食管胃一层吻合术组(C组,138例)。应用同位素测定胃食管反流指数和24h监测pH值,进行3组间的食管运动功能比较。结果同位素测定胃食管反流指数显示,A组反流阳性率为0,B组为33.3%,C组为6.7%。食管运动功能及24h监测pH显示,A组检测各项指标均接近正常值,B、C组与正常值比较,差异具有统计学意义(P<0.05)。结论黏膜瓣式食管胃吻合术式具有优异的抗反流功能,并能有效地防止食管癌、贲门癌术后反流性食管炎的发生。     

Thoracic aortic disease: Spectrum of multidetector computed tomography imaging findings

The clinical presentation of diseases involving the thoracic aorta ranges from a large number of asymptomatic patients with clinically undetectable thoracic aortic aneurysm to patients with symptoms of severe chest pain as a result of acute aortic dissection. Thoracic aortic disease often remains undiagnosed until a life-threatening complication occurs or the disease is discovered serendipitously on imaging studies performed for other purposes. Multidetector row computed tomography (MDCT) imaging of the aorta is used to diagnose various acute and chronic conditions, including aortic aneurysms, aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, traumatic injury, rupture, inflammatory disorders, and congenital malformations. This review illustrates the wide range of MDCT imaging findings of thoracic aortic disease.