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find Author "姜胜利" 3 results
  • Risk Factors for Tromboembolism Events in Patients Undergoing Bioprosthetic Mitral Valve Replacement

    ObjectiveTo investigate the risk or protective factors for systemic embolism (SE) in patients undergoing bioprosthetic mitral valve replacement (MVR). Methods Between October 2002 and March 2013, a total of 146 patients underwent bioprosthetic MVR. There were 78 females and 68 males with mean age of 66.23±5.17 years. The primary reason of mitral valve disease was mitral valve degeneration or mitral valve leaflet prolapse in 40 patients, rheumatic heart valve disease in 101 patients, ischemic heart disease in 3 patients, infectious endocarditis in 1 patient, and mechanical peri-valvular leak in 1 patient. All patients were given anticoagulation therapy with warfarin for 3 months. Thereafter, antithrombotic medication was prescribed according to the surgeon's preference. The patients were followed up by telephone or mail for postoperative condition and SE events. ResultsSixteen (10.96%) patients developed SE events, including cerebral infarction in 13 cases, transient ischemic attack (TIA) in 2 cases and spleen infarction in 1 case. A total of 16 patients died during follow-up. The 1-year, 3-year, 5-year and 10-year cumulative survival rate after surgery was 95.2%, 93.6%, 92.5% and 88.3% respectively. Patients with SE events had lower rate of left atrial appendage obliteration than those without SE events (25.0% vs. 78.6%, P=0.015). Multivariate analysis showed that left atrial appendage obliteration was an independent protective factor for SE in patients undergoing bioprosthetic MVR (P=0.041). ConclusionLeft atrial appendage obliteration is a major protective factor for systemic embolism in patients undergoing bioprosthetic MVR no matter what antithrombotic medication is taken.

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  • Surgical Treatment of Cardiac Complications Caused by Permanent Pacemaker Implantation

    Objective To investigate clinical features and treatment strategy of cardiac complications caused by permanent pacemaker (PPM) implantation.?Methods?We retrospectively reviewed clinical records of 10 patients with cardiac complications caused by PPM who received surgical treatment in General Hospital of People’s Liberation Army from January 2003 to May 2010. There were seven males and three females with an average age of 62.9 years. One patient had an Atrial demand inhibited pacemaker (AAI) PPM and the other nine patients had a DDD PPM. Cardiac complications included infective endocarditis (IE) in 5 patients, tricuspid insufficiency (TI) in 4 patients and pulmonary artery thrombosis in one patient. According to their respective situation, these patients underwent different surgical treatment such as tricuspid valve plasty (TVP), tricuspid valve replacement and/or removal of PPM lead and vegetations as part of intensive debridement of the infected area.?Results?Postoperatively, all the patients were successfully discharged. Five patients whose PPM lines and leads were preserved in the surgery had normal PPM function. Three PPM-dependent patients whose PPM leads were removed in the surgery received a PPM reimplantation later. Nine patients were followed up for an average of 5.5 months and all these patients had a significantly improved quality of life. One patient after TVP had mild TI during follow-up. Conclusion Surgical treatment should be performed as early as possible when infection is too severeto control in patients with IE caused by PPM. PPM-induced TI may be hard to be diagnosed preoperatively, and transesophageal echocardiography or surgical exploration should be considered to establish the diagnosis. Measures should be taken to protect PPM if PPM lines and leads are preserved during operation. Patients whose PPM lines and leads are removed during the surgery need to choose a suitable time for PPM reimplantation.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 25 例急诊心脏瓣膜置换术的临床分析

    目的总结急诊心脏瓣膜置换治疗危重心脏瓣膜病患者的临床经验。方法回顾性分析 2008 年 4 月至 2018 年 4 月内科药物治疗无效的接受急诊手术治疗 25 例重症瓣膜病患者的临床资料(除外主动脉夹层、急诊搭桥同期行瓣膜手术及心脏肿物累及瓣膜手术的病例)。其中男 14 例、女 11 例,平均年龄(45.0±14.6)岁。均合并严重的心功能不全(Ⅳ级),8 例术前需要机械通气。感染性心内膜炎 11 例,均可见明显赘生物,其中 4 例合并瓣周脓肿;瓣膜重度狭窄 8 例,急性瓣膜重度关闭不全 6 例,包括急性腱索断裂 4 例、二尖瓣成形术后失败再次急诊行置换术 2 例。所有患者均在急诊、全身麻醉、体外循环下行瓣膜置换术。结果所有 25 例患者手术后住院期间死亡 6 例(24.0%),其中 5 例死于多脏器功能衰竭,1 例死于感染复发导致的败血症。另有 1 例术中出现Ⅲ度房室传导阻滞安装永久性起搏器;2 例术后早期出现脑出血,经积极治疗后康复,其余均顺利出院。随访 1~120 个月,随访率 100%(19/19),1 例术后 3 个月出现肺部感染死亡,其余患者的心功能均改善明显(Ⅰ级 3 例,Ⅱ级 15 例)。结论手术指征明确的重症瓣膜患者在内科药物治疗无效时应积极选择急诊手术治疗,不仅能够挽救患者的生命,还能提高患者远期生存质量。

    Release date:2019-07-17 04:28 Export PDF Favorites Scan
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