超声心动图对继发性三尖瓣反流术疗效的评价

【摘要】〓目的〓通过超声心动图比较继发性三尖瓣反流患者行三尖瓣缝线成形术和成形环成形术的早期和中期效果,评价两种三尖瓣成形方法的疗效。方法〓回顾性分析我院2008年1月~2013年6月行三尖瓣成形术治疗的,并能追踪到而且进行了随访的继发性三尖瓣反流患者 175 例,根据成形方法分成两组:缝线成形术组 143例(82%),使用成形环成形术组 32 例(18%),分别于术前、术后一个月、术后一年通过超声心动图测量左室射血分数(LVEF)、三尖瓣反流束面积(TRA)、三尖瓣反流分数(TRF)、右室前后径(RVD)、右房上下径(RAD1)及右房左右径(RAD2),比较术前、术后半个月及术后1年时各参数的变化。结果〓两组患者,与术前相比,所有患者术后一个月TRA、TRF及RVD、RAD1及RAD2均显著降低(P<0.05),LVEF无显著变化(P>0.05);术后1年,缝线成形术组的患者TRF较术后一个月显著增加(P<0.05),其余指标无明显变化(P>0.05);而使用成形环组术后一年,所有指标较术后一个月无显著变化(P>0.05)。结论〓三尖瓣成形环成形术治疗三尖瓣反流,在术后中期仍可维持良好的疗效。超声心动图对三尖瓣反流的程度可提供半定量信息,在术前及术后随访中有着重要的应用价值。     

Pulmonary Hypertension in Patients With Severe Aortic Stenosis: Prognostic Impact After Transcatheter Aortic Valve Replacement: Pulmonary Hypertension in Patients Undergoing TAVR

Objectives

The authors investigated the development of pulmonary hypertension (PH), predictors of PH regression, and its prognostic impact on short, mid-, and long-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS).

Treatment of prosthetic tricuspid valve thrombosis with recombinant tissue-type plasminogen activator

Recombinant tissue-type plasminogen activator (rt-PA) was admministeredintravenously to a 64-years old female with thrombotic malfunctionof a Björk–Shiley prosthetic tricuspid valve. 150mg of single-chain rt-PA was infused over 8 hours followed byan additional dose of 50 mg over the next 8 hours. At the endof the first infusion, restoration of normal valve functionwas demonstrated by fluoroscopic and echo-Doppler examinations.Mild systemic activation of the fibrinolytic system occurred,with a decrease of fibrinogen and ₂-antiplasmin to 53% and 33%,respectively, of the preinfusion value at the nadir.     

先天性矫正型大动脉转位行形态三尖瓣置换术

目的 探讨先天性矫正型大动脉转位（C CTGA）患者行形态三尖瓣置换的手术适应证及术后效果.方法 2007年至2012年河南省胸科医院收治CCTGA患者6例,男性5例,女性1例,年龄28～47（34.0±5.2）岁,术前心功能Ⅱ级1例、Ⅲ级5例（NYHA分级）,术前合并室间隔缺损1例、房颤1例、完全性左束支传导阻滞1例、完全性右束支传导阻滞1例、Ⅰ°房室传导阻滞2例.术前形态右心室射血分数（49.0±13.2）％.6例患者均施行形态三尖瓣置换术,术后随访患者心功能、形态右心室射血分数等指标.结果 全组无住院死亡.随访13～72个月,1例患者术后41个月因主动脉夹层死亡,余5例均存活.人工瓣膜功能正常,心功能较术前明显改善,术后1年时心功能Ⅰ级2例、Ⅱ级3例、Ⅲ级1例（NYHA分级）,与术前比较差异有统计学意义（P＜0.05）.术后1年时形态右心室射血分数（48.0±5.6）％,与术前比较差异无统计学意义（P＞0.05）.结论 CCTGA患者行形态三尖瓣置换手术效果满意,能够防止形态右心室功能的进一步损害.     

Clinical Outcome of Isolated Tricuspid Regurgitation

ObjectivesThe aim of this study was to assess the outcome of isolated tricuspid regurgitation (TR) and the added value of quantitative evaluation of its severity.BackgroundTR is of uncertain clinical outcome due to confounding comorbidities. Isolated TR (without significant comorbidities, structural valve disease, significant pulmonary artery systolic pressure elevation by Doppler, or overt cardiac cause) is of unknown clinical outcome.MethodsIn patients with isolated TR assessed both qualitatively and quantitatively by a proximal isovelocity surface area method, a long-term outcome analysis was conducted. Patients with severe comorbid diseases were excluded.ResultsThe study involved 353 patients with isolated TR (age 70 years; 33% male; ejection fraction, 63%; all with right ventricular systolic pressure <50 mm Hg). Severe isolated TR was diagnosed in 76 patients (21.5%) qualitatively and 68 patients (19.3%) by quantitative criteria (effective regurgitant orifice [ERO] ≥40 mm²). The 10-year survival and cardiac event rates were 63 ± 5% and 29 ± 5%. Severe isolated TR independently predicted higher mortality (adjusted hazard ratio: 1.78 [95% confidence interval (CI): 1.10 to 2.82], p = 0.02 for qualitative definition and 2.67 [95% CI: 1.66 to 4.23] for an ERO ≥40 mm², p < 0.0001). The addition of grading by quantitative criteria in nested models eliminated the significance of the qualitative grading and improved the model prediction (p < 0.001 for survival and p = 0.02 for cardiac events). The 10-year survival rate was lower with an ERO ≥40 mm² versus <40 mm² (38 ± 7% vs. 70 ± 6%; p < 0.0001), independent of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (p < 0.0001 for all), and lower than expected in the general population (p < 0.001). Freedom from cardiac events was lower with an ERO ≥40 mm² versus <40 mm² independently of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (p < 0.0001 for all). Cardiac surgery for severe isolated TR was rarely performed (16 ± 5% 5 years after diagnosis).ConclusionsIsolated TR can be severe and is associated with excess mortality and morbidity, warranting heightened attention to diagnosis and quantitation. Quantitative assessment of TR, particularly ERO measurement, is a powerful independent predictor of outcome, superior to standard qualitative assessment.     

Videoscope-assisted cardiac surgery

Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspid valve repair, combined Maze procedure, atrial septal defect repair, ventricular septal defect repair, etc. Hands-on reminders and updated references are provided for reader’s further understanding of the topic.     

Self-Expanding Prostheses for Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement in patients who are considered high surgical risk or inoperable due to advanced age and comorbidities. Randomized trial and registry data have demonstrated the safety and efficacy of TAVR in such patients. Currently available transcatheter heart valves (THVs) employ either balloon-expandable or self-expanding designs, and several new designs have shown promising early results. Differences in valve design may offer specific advantages for accurate deployment and minimizing complications. This article reviews several designs of self-expanding THVs that are currently available or have undergone successful implantation in humans. Additional studies are required to compare the relative performance of these devices.