股浅静脉瓣膜外修复成形术后血流动力学动态变化74例分析

目的检测股浅静脉瓣膜外修复成形术后血流动力学动态变化 ,以分析其治疗下肢深静脉瓣膜功能不全的疗效。方法回顾性分析原发性下肢深静脉瓣膜功能不全 74例 ( 96条肢体 )的资料 ,利用流速剖面图彩超和空气体积描记仪分别于术前、术后 1、3个月及 1年进行血流动力学指标检测并进行统计学分析。结果全组术后静脉返流量、灌注指数、静脉功能不全评分指标于术后 1、3个月、1年均较术前显著降低 (P <0 0 1)。而射血分数、剩余容积分数均值于术后 3个月、1年较术前明显改善 (P <0 0 1)。溃疡愈合率达 78 8% ( 2 6 /33) ,术后 93 6 %的肢体各种症状体征消失和明显缓解。结论股浅静脉瓣膜外修复成形术可显著改善血流动力学状况 ,对治疗原发性下肢深静脉瓣膜功能不全及静脉性溃疡有确切疗效     

主动脉窦瘤破裂合并主动脉瓣关闭不全的手术治疗

１９８１年１月至１９９３年２月手术治疗主动脉窦瘤破裂合并主动脉瓣关闭不全８例，其中６例合并室缺，３例合并房缺。６例主动脉瓣关闭不全是由主动脉瓣脱垂所致，１例因瓣叶穿孔，１例因瓣叶细菌性心内膜炎破坏引起。手术采用升主动脉与窦瘤破人心腔双切口，处理主动脉窦瘤破裂、房缺、室缺以及主动脉瓣关闭不全。４例施行脱垂的主动脉瓣叶折叠悬吊术，４例行主动脉瓣替换术。８例均痊愈出院。随访３个月至８年，８例心功能均改善。     

心室间隔缺损合并主动脉瓣关闭不全的外科矫治

目的：探讨心室间隔缺损（ＶＳＤ）合并主动脉瓣关闭不全（ＡＩ）的外科矫治方法。　　方法：总结１０６例ＶＳＤ合并ＡＩ的外科治疗经验。主要有干下型ＶＳＤ６６例（６２．３％ ）,膜周部ＶＳＤ２２ 例（２０．８％ ）。主动脉瓣以单叶右冠状动脉瓣脱垂为主（７８例占７３．６％ ）;本组单纯ＶＳＤ修补１４ 例;主动脉瓣成形７５例,主动脉成形主要采用脱垂瓣叶折叠悬吊法和中心型折叠法;主动脉瓣置换１７例。　　结果：手术死亡１ 例。出院检查脉压差均恢复正常。心胸比率以及左心室舒张末径均有明显缩小。ＶＳＤ修补术后无残余分流。　　结论：强调早期治疗,防止ＡＩ的进一步发展。主动脉瓣成形是首选方法     

A Tear of the Right Ventricular Outflow Tract during Pulmonary Valvuloplasty Treated by Transcatheter Sapien Valve Implantation

A 74‐year‐old woman was treated by balloon pulmonary valvuloplasty for a symptomatic restenosis 30 years after surgical commissurotomy. The valve dilatation was complicated by a rupture of the right ventricular outflow tract, treated in emergency by a covered stent implantation. The hemodynamic situation was improved, but the free pulmonary regurgitation was leading to a symptomatic right ventricular enlargement. Because surgery was not a good option in this patient at high risk, restoration of pulmonary valve competence was performed by a transcatheter Sapien valve implantation. Transcatheter approach allowed to treat the severe complication of pulmonary valvuloplasty without risk associated with an emergent and redo surgery in a high‐risk patient.     

经皮二尖瓣球囊成形术治疗二尖瓣狭窄伴瓣膜明显畸形的临床疗效观察

分析经皮二尖瓣球囊扩张术（PBMV）治疗二尖瓣狭窄伴严重瓣膜畸形（超声评分≥10分）的临床疗效和安全性。本组共32例，男12例，女20例，平均48岁。手术成功率100％。术后二尖瓣口面积（MVA）从0．91±0．12cm2增加到1．48±0．21cm2（P＜0．05），平均左房压力从23．1±5．2mmHg降到16．8±4．9mmHg，平均肺动脉压从48．9±12．8降到了31．2±14．0mmHg（P＜0．05）。本组手术前后二尖瓣反流程度无明显增加，出院时仅2例发生了明显的二尖瓣反流，无心包填塞、栓塞和死亡，即手术并发症为6．3％。有84％的患者术后心功能改善，心功能恶化者占6．3％。结论：PBMV治疗二尖瓣狭窄伴严重瓣膜畸形的手术成功率高，并发症少，虽对血流动力学的改善不完全，但能改善绝大多数患者的临床症状。     

Mechanolytic management of transcatheter aortic valve thrombosis

Data on the incidence, characteristics, and treatment of thrombosis of a transcatheter aortic valve implantation (TAVI) implant are scarce. We report a challenging case of a TAVI thrombosis occurring 6 months after the procedure. Initial anticoagulation using low-molecular-weight heparin followed by thrombolytic therapy failed to both relieve symptoms and alleviate thrombosis. However, the condition of the patient deteriorated rapidly, necessitating the use of balloon valvuloplasty followed by low-dose thrombolysis. The uniqueness of the case can be summarized as follows: (1) first report of balloon valvuloplasty to manage a case of TAVI thrombosis; (2) thrombolytic therapy after balloon valvuloplasty was successful to further reduce gradient from valve thrombosis.     

三尖瓣关闭不全的外科手术治疗

目的探讨三尖瓣关闭（TI）不全外科治疗的手术特点、方法和疗效。方法行手术治疗的262例TI病人中,器质性TI16例,功能性TI246例,采用三尖瓣成形术（TVP）257例,三尖瓣置换术（TVR）5例。结果术后早期死亡10例,手术死亡率为3．82％。术后随访116倒,平均随访（31．5±11．1）个月。远期死亡3例,远期存活113例中心功能Ⅰ级23例,Ⅱ级71例,Ⅲ级15例,Ⅳ级4例。结论无论是器质性或功能性TI,多数可以行TVP,对无法行成形术的病例应行TVR。右心衰竭与心律失常是三尖辫手术早期和晚期死亡的重要原因,围手术期应加强右心功能的维护和心律失常的防治。     

经皮球囊扩张术治疗二尖瓣狭窄的临床研究

用经皮二尖瓣狭窄球囊扩张术（ＰＢＭＶ）治疗风湿性心脏病二尖瓣狭窄１０５例，手术前后二尖瓣口面积分别为０．９２±０．１８ｃｍ２和１．８６±０．２０ｃｍ２（Ｐ＜０．００１），左心房平均压力分别为２．５８±０．８２ｋＰａ和１．３４±０．６４ｋＰａ（Ｐ＜０．００１），左心房内径分别为４．６±０．４ｃｍ和４．４±０．３ｃｍ（Ｐ＜０．０５），心脏功能明显改善，平均每例好转１．３３级。术中术后无死亡和动脉栓塞病例，出现严重二尖瓣关闭不全、心包填塞、一过性低血压各１例，５例发生短暂性心动过缓，总成功率为９７％。     

ECMO for left ventricular assist in a newborn with critical aortic stenosis

Summary Extracorporeal membrane oxygenation (ECMO) has been used in neonates for a variety of disease states including congenital diaphragmatic hernia, meconium aspiration syndrome, sepsis, and postoperative cardiac compromise. To our knowledge, ECMO has not been employed prior to cardiac catheterization in critical aortic stenosis (CAS). We report a neonatal case of CAS where ECMO was used early as a form of left ventricular assist to achieve adequate systemic perfusion and oxygenation and reduce myocardial ischemia. The patient was maintained on ECMO during subsequent attempts at cardiac catheterization, balloon valvuloplasty, and operative valvotomy.The opinions contained herein are those of the authors and should not be regarded as official or as reflecting the views of the Departments of the Air Force, Navy, or Defense     

经皮球囊肺动脉瓣成形术临床应用

作者1988年～1998年对62名先天性肺动脉瓣狭窄患者实施了经皮球囊肺动脉瓣成形术(PBPV),患者平均年龄201岁。PBPV后即刻肺动脉瓣跨瓣压差(ΔP)由术前71±27mmHg降至37±15mmHg,54例随访1～9年,平均47±21年,ΔP进一步降为24±9mmHg。术中及术后无严重并发症。结论:PBPV治疗肺动脉瓣狭窄安全、有效,即刻与中远期效果均良好。