升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

经食管超声心动图在胸主动脉瘤介入治疗中的应用

血管内修复术创伤性小，可应用于治疗多种主动脉疾病，如动脉瘤和主动脉夹层。经食管超声心动图(TEE)对主动脉疾病很敏感。术前可通过TEE找到撕裂的内膜片、发现内膜破口、区分类型、区分真假腔及了解心脏状况。术中TEE用于引导导管插至正确位置、观察支架放置过程、监测心功能和室壁运动状况、评价手术疗效。术后随诊通过TEE观察支架内血流情况、检出并发症如内漏等。     

Carpentier-Edwards pericardial aortic valve in middle-aged patients comparison with the St. Jude medical valve

Objective The objective of the present study was to compare long-term results of single aortic valve replacement (AVR) with mechanical (St. Jude Medical valves: standard) and biologic (the Carpentier-Edwards pericardial) prostheses. Method: Between 1995 and 2002, 95 patients who underwent single AVR with mechanical (n=46) or biologic (n=49) prostheses were enrolled in this study. The mean age at the operation was 54.0±9.6 years (range: 20 to 69 years) with the mechanical and 68.8±7.1 years (range: 44 to 85 years) with the biologic prosthesis. Results: The 9-year actuarial survival rate, which was calculated by taking perioperative mortality into account, was 90.3±4.6% for patients with mechanical valves and 87.6 ±4.8% for patients with bioprostheses, with no difference between the two groups (p=0.342). The 9-year freedom rate from thromboembolism, reoperation, endocarditis was 94.8+3.6%, 100% and 97.8 ±2.2% for patients with mechanical valves and 98.0 ±2.0%, 97.5 ±3.4% and 95.0 ±3.4% for those with bioprostheses, respectively. After 9 years, freedom from cardiac death averaged 97.8% in the group with mechanical valves compared with 95.3% in those with bioprostheses (p=0.541). Conclusion: We conclude that the mid-term durability of the Carpentier-Edwards pericardial valve in the aortic position for the elderly is excellent. Nevertheless, the risk of tissue valve reoperation progressively increases with time, and a longer follow-up may be necessary to provide its value compared with the mechanical valves in a country like Japan with a high life expectancy. (Jpn J Thorac Cardiovasc Surg 2005; 53:465-469)     

老年腹主动脉瘤非手术治疗的长期超声随访研究

目的超声随访观察经非手术治疗的老年腹主动脉瘤的发展变化规律。方法超声随访诊断明确、病历及影像学资料完整的老年腹主动脉瘤非手术治疗患者37例，按首次发现时瘤体大小分3组，定期测量并记录各组腹主动脉扩张最明显处横切面直径，计算年增长量。结果37例腹主动脉瘤首次发现时瘤径大小平均为4．68cm，随访年限0．5～11年，平均6．1年，瘤径平均每年增长0．47cm。14例瘤径小于4．0cm，平均年增长0．23cm，15例瘤径小于6．0cm，平均年增长0．37cm，8例瘤径大于6．0cm，平均年增长0．67cm。随访期间死亡5例，其中因动脉瘤破裂死亡2例，破裂前瘤径大小分别为8．35cm、8．91cm。7例随访期间因瘤径短期内明显增大而行腹主动脉瘤腔内支架隔绝术。结论老年腹主动脉瘤瘤径小于6．0cm者随增龄增长缓慢，大于6．0cm者随增龄增长快，应进行积极的外科干预。     

MRI在心脏瓣膜病中的诊断价值

目的 探讨多序列MR扫描在心脏瓣膜病中的诊断价值。方法 回顾性分析56例心脏瓣膜病患者的影像学资料，患者分别采用超声心动图（UCG）、二维（2D）黑血及亮血序列、K-空间节段真实稳态进动快速扫描序列（True FISP）对瓣膜病进行定性评价，15例患者还进行小角度快速激发（FLASH）电影序列和流速编码电影（VEC）定量分析，并将MR结果与UCG进行对比。结果 UCG和MRI诊断二尖瓣狭窄（MS）2例，二尖瓣关闭不全（MI）23例；主动脉瓣狭窄（AS）7例，其中二瓣畸形5例；主动脉瓣关闭不全（AI）13例；三尖瓣关闭不全（TI）2例；复合或联合瓣膜病9例。受累心腔的增大和升主动脉的扩张是其主要形态学改变，异常的血液湍流信号是受累瓣膜的直接征象。VEC-MR定量分析与多普勒超声一致性好：6例AS，MR和UCG检查结果相关性分析，相关系数和校正相关系数分别为：R=0，975、Rsq=0．951（P〈0．01），AI9例，分别为R=0．965、Rsq=0．932（P〈0．01）。结论 MR多序列综合扫描可对心脏瓣膜病特别是主动脉瓣疾病进行准确的定性及定量评价。     

应用同种动脉治疗主动脉根部病变

报告５例采用同种动脉（ＨＡＶ）治疗５例主动脉根部病变（主动脉瓣狭窄１例，关闭不全４例）。男３例，女２例；年龄１３～４７岁。病因为细菌性心内膜炎２例（包括先天主动脉瓣二瓣化畸型１例），Ｍａｒｆａｎ综合征２例，风湿性主动脉瓣关闭不全１例。术中采用同种主动脉全根置换３例（Ｂｅｎｔａｌｌ手术），其中１例用ＨＡＶ上的二尖瓣前叶加宽主动脉瓣环（Ｍａｎｏｕｇｕｉａｎ手术），余２例用自体肺动脉移置主动脉根部，另取同种肺动脉做原位移置（Ｒｏｓｓ手术）。结果死亡１冽，４例存活，且无并发症发生。术后超声心动图提示主动脉根部良好，无主动脉瓣反流。随访２．５～３．５年疗效满意。     

复合带瓣人工血管替换升主动脉和主动脉瓣(24例报告)

报告２４例升主动脉瘤伴主动脉瓣关闭不全行升主动脉和主动脉瓣替换及冠状动脉开口移植术（Ｂｅｎｔａｌ术２２例，底盘法２例）。１３例伴有升主动脉夹层分离，对其中８例ＤｅＢａｋｅｙＩ型者，以Ｔｅｆｌｏｎ毡条内外加固主动脉切端后吻合。１３例用人工血管周围间隙与右心耳吻合以控制升主动脉吻合之外的出血。３例以人工血管片环包主动脉吻合口控制局部广泛渗血及出血。２例术毕不能脱离体外循环死亡，手术死亡率８３％。随访平均２１８个月，２例死于蛛网膜下腔出血，１例右股动脉栓塞经手术治愈；其余病人康复良好，心功能（ＮＹＨＡ）Ｉ～ＩＩ级。     

温缺血时间与同种心脏瓣膜细胞活性的关系

以１０具脑外伤死亡的健康男性的心脏的６０个同种主动脉、肺动脉瓣叶分为６组进行实验。经不同的温缺血时间灭菌并经过３个月的液氮深低温保存后，通过流式细胞计数测定细胞活性，同时行组织块贴壁培养及电镜观察。结果表明：温缺血时间在１２小时以内，细胞活性为９３．４９±２．３５％，较对照组无明显下降。灭菌２４小时，细胞活性为８９．８２±３．５２％，较对照组明显下降，Ｐ＜０．０１，并且可见形态上改变；冷冻后细胞活性进一步下降，但下降幅度减低，冻存３年后活细胞仍占８０％。结论为：温缺血时间对细胞活性有影响，时间延长与活性的下降成正相关。因此温缺血时间应控制在１２小时以内。     

利多氟嗪加强间断缺血心停搏心肌的保护作用

通过对16条犬常温下用利多氟嗪(lidoflazine)预处理加强间断主动脉阻断心停搏心肌保护作用的实验研究。16条犬随机分为对照组和实验组。结果发现,实验组心脏血流动力学的恢复要明显优于对照组。二组间心肌组织ATP、腺苷和肌苷以及冠脉回流液中CPK、CPK-MB、LDH、SOD和MDA值均有显著性差异(P>0.05)。作者认为,冠脉搭桥术中采用间断缺血心停搏时加用利多氟嗪有利于保存心肌能量,减轻心肌再灌注损伤和术后迅即恢复心脏功能。     

新的钙通道阻滞剂 MC9204 对离体兔动脉环的作用

目的：比较ＭＣ９２０４和ｎｉｆｅｄｉｐｉｎｅ（ＮＩＦ）的扩血管强度，并观察ＭＣ９２０４是否具有血管选择性作用。方法：采用离体血管张力实验法，观察ＭＣ９２０４和ＮＩＦ的扩血管作用。结果：ＭＣ９２０４和ＮＩＦ对ＫＣｌ、ＣａＣｌ２和去甲肾上腺素（ＮＥ）引起的离体兔动脉环收缩反应均具有显著的拮抗作用，使剂量－效应曲线右移。在ＮＥ双相收缩实验中，二药均可显著抑制ＮＥ依外Ｃａ２＋性收缩反应，而对ＮＥ依内Ｃａ２＋性收缩反应无抑制作用。结论：ＭＣ９２０４扩血管作用强于ＮＩＦ，ＭＣ９２０４对肾动脉和肠系膜上动脉的抑制作用强于腹主动脉，具有一定的血管选择性作用，此作用通过抑制细胞外Ｃａ２＋的进入而实现。