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find Author "张怀军" 9 results
  • Using SelfPericardial Patch Heightening to Treat Aortic Valve Prolapse

    Objective To summarize the clinical experiences of using selfpericardial patch heightening to treat aortic valve prolapse. Methods From May 2000 to July 2007, seventeen patients with aortic valve prolapse were treated by selfpericardial patch heightening. Fifteen cases had right coronary cusp prolapse, one had left coronary cusp prolapse, and one had no coronary cusp proplapse. There were 10 cases with moderate aortic regurgitation and 7 with severe regurgitation. Autologous pericardium was continuously sutured on the proplapsed cusp by 5-0 or 6-0 Prolene suture. The transesophageal echocardiography(TEE) showed that there was few or mild aortic regurgitation during operation. Preoperative and postoperative echocardiography results were compared. Results The comparison between preoperative and postoperative echocardiography results showed that postoperative left ventricular enddiastolic diameter reduced obviously(38.3±9.6 mm vs. 47.2±10.3 mm,P=0.013);postoperative aortic valve systolic pressure difference reduced(9.8±5.6 mm Hg vs. 10.3±5.3 mm Hg,P=0.792); postoperative aortic valve diastolic pressure difference reduced obviously(45.7±13.6 mm Hg vs. 78.4±19.9 mm Hg,P= 0.000). Echocardiographic examination before discharge showed that 4 cases had no obvious aortic regurgitation, 9 had mild aortic regurgitation and 4 had moderate aortic regurgitation. The average followup time was 32 months(4.74 months). One case underwent aortic valve replacement because of severe aortic regurgitation 4 months later after the operation, and the rest needed no second operation. Conclusion Using selfpericardial patch heightening to treat aortic valve prolapse is a simple operative method, and it is good for young patients or small aortic annulus.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 成人主动脉缩窄的临床特点和外科矫正

    目的探讨成人主动脉缩窄的临床特点和外科治疗方法。方法40例成人主动脉缩窄患者行手术矫治,其中心脏不停跳手术28例,常规体外循环下手术12例。行主动脉狭窄段切开、人工血管补片扩大术12例,人工血管置换术15例,锁骨下动脉降主动脉旁路移植术1例,采用人工血管行胸一腹主动脉旁路移植术9例,经心包后径路行升主动脉一降主动脉旁路移植术3例。结果全组无手术死亡,几种术式术后均无脑部和脊髓等神经系统并发症。术后36例得到随访,平均随访12个月。36例患者上、下肢血压差均小于10mmHg(1kPa-7.5mmHg)。超声心动图和超高速CT检查提示人工血管血流通畅,无假性动脉瘤形成。结论成人主动脉缩窄的外科术式有多种选择,掌握好手术适应证,根据患者的具体病理生理状况选择合适的手术方式可获得满意的治疗效果。

    Release date:2016-08-30 06:18 Export PDF Favorites Scan
  • Effects of Cannulation Site on Myocardial Oxygen Metabolism During Left Ventricular Assistance

    Objective To compare the effects of two kinds of cannulation sites on the myocardial oxygen metabolism during left ventricular assistance to provide experimental basis for clinical selection of proper cannulation sites. Methods Twelve mongrel dogs were randomized equally into the left atrium to aorta group (LA group) and left ventricle to aorta group (LV group), and underwent left ventricular assistance. At different times before and during left ventricular assistance, the heart rate, coronary sinus flow rate and blood gas were determined and coronary sinus oxygen saturation, arteriovenous oxygen difference and myocardial oxygen consumption were calculated. Results There was no statistical difference of heart rate in both groups(P〉0. 05). The coronary sinus flow rate and mean myocardial oxygen consumption reduced in both groups after left ventricular assistance, whereas the effect was more remarkable in the LV group (P〈0.01). Conclusion Both cannulation methods could reduce the myocardial oxygen consumption during left ventricular assistance, and the effect is more apparent in left ventricular cannulation.

    Release date:2016-08-30 06:18 Export PDF Favorites Scan
  • 法洛四联症根治术后肺动脉瓣置换术

    目的 讨论法洛四联症 (TOF)术后肺动脉瓣关闭不全的外科治疗时机和方法。 方法  5例 TOF患者行根治术后发生严重肺动脉瓣关闭不全 ,选用液氮保存的同种带瓣肺动脉行肺动脉瓣置换术 (PVR) ,并同期分别行三尖瓣成形术 (TVP)、右心室流出道 (RVOT)成形术、VSD残余漏修补术或 RVOT疏通。 结果  1例术后早期因进行性右心功能衰竭死亡 ;余 4例均恢复良好 ,无严重心律失常 ;分别随访 3个月~ 4年 ,心功能为I ~II 级。 结论 早期 PVR能明显改善右心功能 ;采用同种带瓣肺动脉手术简便 ,早期效果满意。

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • Emergency Coronary Artery Bypass Grafting after Failed Percutaneous Coronary Intervention

    Objective To summarize the experience of emergency coronary artery bypass grafting (CABG) after failed percutaneous coronary intervention. Methods From January 1998 to December 2002, 9 patients underwent emergency CABG after failed percutaneous coronary intervention. The indications of emergency CABG were coronary artery dissection (5 cases)or perforation (2 cases) and acute arterial occlusion (2 cases). The time averaged 2 hours from onset of ischernia to revascularization. The CABG was performed under off-pump bypass in 3 cases and under CPB in 6 cases. The mean graft number was 3. Results There were no hospital death. The mean follow-up was 17 months. No death and angina occurred. The function of New York Heart Association class Ⅰ-Ⅱ were in 8 patients, class Ⅲ in 1 patient. Conclusion Emergency CABG is an effective management for failed percutaneous coronary intervention if the indication is right.

    Release date:2016-08-30 06:26 Export PDF Favorites Scan
  • 先天性心脏病三尖瓣关闭不全的外科治疗

    目的 为提高先天性心脏病三尖瓣关闭不全外科治疗的疗效 ,总结其外科治疗经验。 方法  1995~2 0 0 1年 ,共收治 16例先天性心脏病三尖瓣关闭不全患者 ,三尖瓣中度反流 3例 ,重度反流 13例。行单纯 De Vega环缩术 7例 ,De Vega环缩加前叶腱束缩短、隔叶腱束转移、裂修补和前叶自体心包扩大术各 1例 ,应用三尖瓣人工瓣环 3例 ,三尖瓣置换术 2例。 结果 全组无手术死亡。随访所有患者 ,平均随访 38个月 ,1例单纯 De Vega环缩术患者于术后 4年出现中至重度三尖瓣关闭不全。 结论 先天性心脏病三尖瓣关闭不全患者的外科治疗首选三尖瓣成形术 ,De Vega成形术环缩瓣环方法简便、有效。

    Release date:2016-08-30 06:27 Export PDF Favorites Scan
  • Emergency surgery on severe myocardium ischemia of early post-coronary artery bypass grafting

    Objective To summarize the experience of emergency coronary artery bypass grafting(CABG) on serious myocardium ischemia in early post CABG. Methods Between 1998 and 2002, emergency redo CABG was performed in 13 patients with serious early post operative myocardium ischemia. The causes included vein graft embolize(4 cases),uncompleted revascularize(3 cases), graft spasm(1 case) and anastomose stenosis or occlusion (5 cases). The grafts was 1 3(1.8±0.9) during redo CABG. Results There were 6 deaths, the mortality was 46%. The mean follow up was 31 months. There was no recurrence of angina. NYHA function was Ⅰ Ⅱ. Conclusion Emergency CABG is an important method in saving the patients with severe myocardium ischemia in early post CABG. The perioperative prevention and early treatment should be emphasized.

    Release date:2016-08-30 06:27 Export PDF Favorites Scan
  • 先天性心脏病继发感染性心内膜炎的外科治疗

    目的 总结先天性心脏病继发感染性心内膜炎41例外科治疗的经验。方法 手术均在体外循环下进行畸形矫正和赘生物清除。室间隔缺损(VSD)直接缝合16例,补片修补10例;动脉导管未闭(PDA)均采用直视缝合法。同期行肺动脉瓣成形术5例,三尖瓣置换术2例,主动脉瓣置换术12例,主动脉瓣和二尖瓣置换术2例。结果 1例急诊VSD修补同时行主动脉瓣置换术,术后并发脑栓塞死亡;其余患者均痊愈出院。随访35例,随访时间3~102个月,无1例死亡和心内膜炎复发。结论 正确把握手术时机和使用有效抗生素是提高治愈率的关键,应强调对先天性心脏畸形的早期治疗,以防止严重并发症。

    Release date:2016-08-30 06:33 Export PDF Favorites Scan
  • Clinical Features and Surgical Strategy of Ebstein's Anomaly in Adults

    ObjectiveTo analyze clinical features and surgical strategies of Ebstein's anomaly (EA) in adults. MethodsSeventy-eight adult patients with EA underwent surgical treatment in Fu Wai Hospital from January 2008 to December 2011. There were 24 males and 54 females with their age of 18-54 (33.0±9.5) years. Preoperatively, 72 patients were in NYHA class Ⅰ or Ⅱ, and 6 patients were in NYHA class Ⅲ or Ⅳ. Clinical presentations mainly included exercise capacity deterioration and exertional dyspnea. Preoperative echocardiography showed downward displacement of the septal leaflet (SL) of the tricuspid valve (TV) of 34.8±12.7 (20-60) mm. Three patients had severe dysplasia or agenesis of tricuspid SL. Downward displacement of the posterior leaflet (PL) of TV was 46.8±11.6 (20-70) mm, and 1 patient had agenesis of tricuspid PL. Average TV annulus was significantly enlarged with 60±10 (37-70) mm. Mean atrialized portion of the right ventricle was about 40%. There were 18 patients with moderate tricuspid regurgitation (TR) and 60 patients with moderate-to-severe TR. Seventy-five patients received tricuspid valvuloplasty (TVP). Fifty-six patients received plication of the atrialized right ventricle (ARV), 20 patients received ARV resection, and 2 patients didn't receive any specific management of ARV. Thirty-two patients received TVP with a prosthetic ring. Three patients underwent tricuspid valve replacement. ResultsTwo patients died posto-peratively, and in-hospital mortality was 2.5%. Postoperative recovery of the survival patients was good. There was no severe atrioventricular block or other complication. Echocardiography before discharge showed good function of TV without moderate or more severe TR. Mean follow-up was 26 months. None of the patients needed re-operation. ConclusionThe incidence of acute heart failure in EA adults is low. TVP is the main surgical procedure to achieve main goals of surgical treatment including improvement in heart function, exercise capacity and quality of life.

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