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find Keyword "三尖瓣置换术" 20 results
  • Early and Mid-term Outcomes of Morphologic Tricuspid Valve Replacement with Preservation of Entire Valvular and Subvalvular Apparatus in Corrected Transposition of Great Arteries

    Abstract: Objective To investigate the early and mid-term outcomes of morphologic tricuspid valve replacement by means of intravalvular implantation in corrected transposition of great arteries(cTGA). Methods From January 2009 to January 2012,11 patients with cTGA were surgically treated in Fu Wai Hospital. There were 9 male patients and 2 female patients with their mean of age of(37.8±11.7)years and mean body weight of(73.0±11.3)kg. All the patients underwent morphologic tricuspid valve replacement with preservation of the entire valvular and subvalvular apparatus. Simultaneous surgical procedures included repair of ventricular septal defect in 2 patients,repair of atrial septal defect in 4 patients,pulmonary valvuloplasty in 1 patient,reconstruction of functional right ventricular outflow tract in 4 patients and repair of coronary-pulmonary artery fistula in 1 patient. Postoperative New York Heart Association (NYHA) classification, cardiothoracic ratio, morphological right ventricle ejection fraction, end-diastolic dimension of morphological right ventricle and left atrium were evaluated during follow-up. Results All the 11 patients were successfully surgically treated and followed up for an average duration of(13.0±10.6)months. There was no statistical difference between postoperative and preoperative average cardiothoracic ratio (0.54±0.06 vs. 0.57±0.09,t=1.581,P>0.05),morphologic right ventricle ejection fraction (52.8%±9.0% vs. 54.9%±9.5%, t =0.712,P>0.05),and end-diastolic dimension of . morphological right ventricle (54.3±7.5 mm vs. 56.9±9.2 mm,t =0.988,P>0.05). There was statistical difference between postoperative and preoperative average end-diastolic dimension of left atrium(42.1±8.9 mm vs. 53.4±11.1 mm,t =3.286,P<0.05)and NYHA classification(Z = -2.640,P<0.05). Conclusion Intravalvular implantation of morphologic tricuspid prosthesis can protect the physiological structure of morphologic right ventricular and prevent furtherdamage to its function caused by morphologic tricuspid valve insufficiency. Postoperative dimension of morphologic left atrium and cardiac function are significantly improved. The early and mid-term outcomes are satisfactory.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • The Advance of Surgical Treatment of Ebstein Anomaly

    Abstract: Ebstein anomaly is a relatively rare congenital heart malformation which can affect heart function significantly. It may cause right heart failure, even whole heart failure and eventually death. In recent years, the surgery has made much progress in dealing with the abnormal valve, improving the right ventricle function and pretreatment of its related complications. However, because of its complexity and diversity in pathological anatomy and clinical manifestations, the disease has not got an “almighty standard” to treat all pathological anatomy types of the deformity, or asurgery strategy to solve the practical problems encountered in all clinic situations. Furthermore, the therapeutic effect is also unsatisfactory. This article will review the advance of treatment of Ebstein anomaly and prevention of its related complications.

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • Mid and Long Term Outcomes of the Morphologic Tricuspid Valve Replacement for Patients with Corrected Transposition of the Great Arteries

    Objective To investigate the surgical indications and the mid and long term results of morphologic tricuspid valve replacement for corrected transposition of the great arteries(cTGA). Methods From September 1997 to September 2007, 18 cases with cTGA were treated in Fu Wai Hospital. There were 15 male and 3 female, aged from 16 to 51 years(33.3±12.8 years), and weighed from 47 to 90 kg(60.9±14.7 kg). There were 10 cases with isolated morphologic tricuspid valve insufficiency, 3 complicated with ventricular septal defect, 2 complicated with ventricular septal defect and pulmonary valve stenosis, 2 with morphologic tricuspid valve insufficiency after septal defect repair, and 1 with mechanical valve dysfunction after morphologic tricuspid valve replacement. The preoperative mean morphologic right ventricle ejection fraction was 562%±11.6%. Of the 18 cases, 12 were in grade Ⅱ and 6 were in grade Ⅲ according to New York Heart classification(NYHA).All the cases had undergone morphologic tricuspid valve replacement. Postoperative indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results One patient died of postoperative low cardiac output syndrome. Two had pervavlvular leak, which were cured by pervavlvular leak repair at 7th and 30th day after operation, respectively. Sixteen were followed up with a followup time of 57.0±407 months. There was no statistical significance between preoperative and postoperative mean morphologic right ventricle ejection fraction(52.8%±9.2% vs.56.2%±11.6%; t=2.062, Pgt;0.05). The followup showed that 12 were in NYHA grade Ⅰ or Ⅱ, and 4 were in NYHA grade Ⅲ. There was no statistical significance between preoperative and postoperative percentage of cases in NYHA grade Ⅲ(χ2=1.532,Pgt;0.05). Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function caused by morphologic tricuspid valve insufficiency. The mid and long term results were satisfying. During the followup, the morphologic right ventricle can function appropriately.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 三尖瓣置换术的临床应用

    目的 总结三尖瓣置换术(tricuspid valve replacement, TVR)治疗三尖瓣病变的经验,探讨手术指征、方法,以提高临床治疗效果。方法 回顾性分析2003年1月至2007年4月期间24例接受TVR患者的临床资料,其中风湿性心脏病15例,Ebstein畸形5例,先天性三尖瓣发育不良2例,感染性心内膜炎1例,外伤1例;再次手术患者4例。 结果 院内死亡2例,死亡率8.3%(2/24)。术后发生并发症2例,其中一过性Ⅲ°房室传导阻滞1例,安置心内临时起搏器20d后恢复;病态窦房结综合征1例,经使用临时心外膜起搏器15d后,恢复自主心律。经门诊随访19例(86.4%),心功能恢复至Ⅰ级12例,Ⅱ级7例。 结论 严格把握手术指征,加强围术期处理,行TVR安全、可靠、疗效满意。

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • The Early and Middlelongterm Clinical Results of Tricuspid Valve Replacement

    Objective To evaluate the early and middlelongterm clinical results of tricuspid valve replacement (TVR) and compare the relative merit between bioprothesis and mechanical valve in tricuspid position,so as to elevate the operative effect. Methods The data of 128 TVR from April 1992 to February 2008 in An Zhen Hospital were retrospectively reviewed, and classified into mechanical prosthesis group(n=89)and bioprothesis group(n=39)according to the prosthesis used in the first procedure. Kaplan-Meier curve were estimated to evaluate the midlong term survival rate and events incidence related to prosthesis(including thrombosis, embolism and bleeding related to prosthesis and the prosthesis deterioration). Multivariate binary logistic regressions were used to evaluate the independent risk factor for early and late death. Results There were 19 early deaths( 14.84%). With the followup of 4.93±2.92 years, there were 11 late deaths(10.7%). According to the Kaplan-Meier curve, the 10year actuarial survival rate for the bioprothesis group and mechanical prosthesis group were 65.6%±17.4% and 68.7%±10.8% respectively(Log-rank test,χ2=0.74,P=0.390). Freedom from prosthesis-related embolism at 5 years for the bioprothesis group and mechanical prosthesis group were 92.3%±7.4% and 87.1%±4.6% respectively(Log-rank test, χ2=0.962,P=0.327). Freedom from anticoagulationrelated bleeding at 10 years for the bioprothesis group and mechanical prosthesis group were 100% and 79.7%±9.7% respectively(Log-rank test, χ2=1.483,P= 0.223). There were 9 TVR reoperation, freedom from reoperation at 7 years for the bioprothesis group was 71.1%±18.0%, and freedom from reoperation at 10 years for the mechanical prosthesis group was 78.8%±10.2% (Log-rank test, χ2=2.76,P=0.096). Binary logistic regression revealed that the redo procedure and ascites were independent risk factors for early death, whereas ascites, heart function of New York Heart Association class Ⅲ/Ⅳ and multi valve replacement were independent risk factors for late death.Conclusion To lower the operative mortality and late mortality and morbidity, TVR should be adopted prior to the deterioration of right heart function, and bioprothesis valve has similar early and middlelong term clinical effect with mechanical valve in tricuspid position.

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • Clinical Characteristics and Management of Patients with Severe Tricuspid Regurgitation after Mitral Valve Surgery

    Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • Tricuspid Valve Replacement: A Report of 13 Cases

    Abstract: Objective To summarize the clinical experience of 13 patients of tricuspid valve replacement and to investigate the indication and method. Methods From January 1994 to December 2005, the clinical datum of the thirteen patients suffering from tricuspid valve disease were reviewed, including rheumatic heart disease 6 cases, congenital heart disease 3 cases, infective endocarditis 3 cases and right ventricular tumor 1 case. All the cases underwent tricuspid valve replacement. Results Two reoperative rheumatic heart disease patients died early after operation and their cardiac function was New York Heart Association (NYHA) class Ⅳ before operation. The followup interval was 3 months to 12 years in 11 cases. There were 2 late death, one died of recurrence of infective endocarditis, and another died of the recurrence of the tumor. One Ebstein anomaly case’s NYHA functional recovered to class Ⅲ, eight cases’s recovered to NYHA classⅠ-Ⅱ. Conclusion The tricuspid valve disease may be a secondary lesion from many causes. Indication of tricuspid valve replacement must be strictly commanded. The late results of tricuspid valve mechanical prostheses replacement is satisfactory.

    Release date:2016-08-30 06:13 Export PDF Favorites Scan
  • The Clinical Research of Tricuspid Valve Replacement in the Treatment of Ebstein’s Anomaly

    Objective To evaluate the effect of treating Ebstein ’s anomaly w ith tricuspid valve replacement (TVR), and analyze the indications and personali ze the surgical methods of TVR. Methods 35 TVR in 32 cases of Eb stein’s anomaly not amenable to repair from May 1993 to June 2007 in An zhen Hospital were retrospectively. The mortality and complication incidence wer e estimat ed and the KaplanMeier survival curves were constructed to estimate actual sur vival and freedom from thrombus embolism rate, and comparative studies were unde rtaken to e valuate the clinical effect between implanting the prosthesis in the original tr icu spid ring or above the coronary sinus, and between fold the atrialized ventricle or not, and between preserve the autologous tricuspid or not. The univariate an alysis and logistic regression were used to explore the early and late death ris k factors. Results There were 2 early hospital death (6.25%). Followup of 30 patients who survived 30 days ra nged up to 14 years (4.2±3.5years),there were 3 TVR reoperation due to the pro sthesis deterioration. There were 2 late deaths(6.67%), and the actuarial surv i val at 5,10 year was 92.1%±4.6%, 86.5%±5.8% respectively in KaplanMeier cu rve. There were 2 events of thrombus embolism that were cured through thromboly tic therapy, thus the freedom from thrombus embolism at 5 and 10 yers reached 91 . 3%±4.5%,82.3%±4.2% respectively. 24 late survivors were in New York Heart Ass ociation(NYHA) functional cl ass I, and 4 in NYHA functional class II. The incidence of atria ventricular nod e rhythm in patients with the prosthesis implanted in original tricuspid ring wa s statistically higher than that of prosthesis implanted above the coronary sinus,and the incidence of paradoxical ventricular septal motion in patients wi thout folding the atrialized ventricle was statistically higher that of with fol ding the atrialized ventricle, but the NYHA functional class was not affected by these factors.The univariate analysis and logistic regres sion revealed that preoperative functional right ventricle/atrialized ventriclelt; 1 and ascites were the independent risk factor for the early death (P=0.023, 0.025), whereas preoperative ascites and edema in lower extremities were the in dependent risk factors for late death (P=0.026, 0.019). Conclusion TVR is a good therapeutically option for Ebstein’s anomaly si nce the operative risk is low, the functional status improved in all patients an d the durability of prosthesis in tricuspid position has been good. In order to maximize the effect of the TVR in Ebstein’s anomaly, personalized procedure sho uld be adopted in deciding whether to fold the atrialized ventricle or not, to p reserve the autologous tricuspid valve or not, and to implant the prosthesis in the original tricuspid ring or above the coronary sinus.

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • Tricuspid Valve Replacement: Medium-and Long-term Results in 67 Cases

    Objective To analyze the medium-and long-term r esults of tricuspid valve replacement(TVR), to summarize the experience in opera tive therapy for tricuspid valve disease. Methods From January 1998 to May 2006, sixty seven patients had undergone TVR. The etiology was rheumatic disease in 25 cases, congenital disease in 37 cases, degenerative disease in 1 case, infective endocarditis in 3 cases, a nd cardiac tumor in 1 case. All operations were performed under general anesthes i a and by cardiopulmonary bypass. Bioprostheses was replaced in 28 patients, whil e mechanical valve was replaced in 39 patients. Associated procedure included mi tral valve replacement in 13 cases, mitral valve replacement and aortic valve replac ement in 12 cases, repair of ventricular septal defect in 1 case, repair of atri al septal defect in 1 case, and radioablation of atrial fibrillation in 3 case s. Results The operative mortality was 11.94% (8/67),among these patients , 6 cases died of serious heart failure,1 case died of ventricular fibrillation, 1 case died of multi organ failure. During follow-up, 1 patient died of biopro thesis dysfunction 1 year after the operation, 1 patient died of cerebral emboli s m 6 years after the operation. Through statistical analysis, it showed that the mortality of TVR in rheumatic tricuspid valve disease was higher than that in co ngenital tricuspid valve disease [5.56%(2/36)vs. 24.00% (6/25); χ2=4.425 , P=0.036]; the mortality in second time operation was higher than that in first time operation [30.00%(3/10)vs. 8.77% (5/57);χ2=3.646,P=0.033 ]; while there was no significant difference in immediate and long-term result s with different choice of bioprosthetic or mechanical valve in TVR (χ2=0.002 , P=0.961). Conclusion Operative an d follow-up mortality is high in the TVR, valve replac ement is the last selection for the treatment of serious tricuspid disease, appr opriate operative technique and perioperative therapy is the key for success o f the operation.

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • 二尖瓣置换术后三尖瓣关闭不全的外科治疗

    目的总结二尖瓣置换术后三尖瓣关闭不全患者的外科治疗经验。方法14例心脏瓣膜疾病患者行二尖瓣置换术后发生中度或重度三尖瓣关闭不全,其中相对性关闭不全12例,器质性关闭不全2例。行三尖瓣成形术4例,均使用人工瓣环成形;行三尖瓣置换术10例,其中置换生物瓣6例,双叶机械瓣4例。在心脏不停跳下手术4例,常规心脏停搏手术10例。结果全组无手术死亡,术后发生低心排血量综合征3例,用升压药维持循环,患者均顺利出院。术后复查超声心动图,右心房、室均明显缩小,右心室前后径(22.5±5.6mm)较术前(31.9±5.9mm)明显减小(Plt;0.001)。随访14例,随访时间1.8±1.3年,心功能级2例、级9例,级2例,1例于术后4年因心力衰竭死亡。结论二尖瓣置换术后远期三尖瓣关闭不全的患者经外科矫治后疗效满意,合理掌握手术指征、手术时机和良好的围术期治疗是手术成功的关键。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
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