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find Keyword "心脏瓣膜疾病" 26 results
  • History and Research Advance of China-made Mechanical Heart Valves

    Clinical application history of prosthetic heart valves has been over five decades, and mechanical heart valves have satisfactory clinical outcomes for surgical treatment of valvular heart disease. The development history of mechanical heart valves experienced from the first generation of ball valves and caged disc valves to the second generation of single tilting disc valve, and to the third generation of bileaflet valves. In 1960, ball valve was first used for heart valve replacement in abroad. In 1963, China-made ball valve was also produced and used in clinical practice. In 1969, the second generation of single tilting disc valve was developed in abroad. In 1978, China-made single tilting disc valve was produced and widely used in clinical practice with satisfactory clinical outcomes. Since 1980 when it was first produced, bileaflet valve has taken the place of above 2 types of valves for its excellent performance, and become the mainstream product all over the world. Currently, the development of China-made bileaflet valves has lagged behind, and domestic mechanical heart valve market has almost been monopolized by foreign bileaflet valve products. Therefore, the development of ideal China-made mechanical heart valve deserves further research.

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • Myocardial Protection by Different Myocardial Protective Strategies in Double Valve Replacement

    Abstract: Objective To evaluate myocardial protection effect of different myocardial protective strategies for patients undergoing double valve replacement (DVR) . Methods From Jun. 2005 to Dec. 2005, 32 patients with predominant aortic valve stenosis undergoing DVR in Xinqiao Hospital were included in this study. These patients were randomly divided into four groups with 8 patients in each group: (1) antegrade perfusion group:Cold-blood cardioplegia was delivered antegradely through aortic root, and mitral valve replacement (MVR)was performed. Then cold-blood cardioplegia was delivered antegradely through left and right coronary ostia, and aortic valve replacement (AVR) was performed; (2)retrograde perfusion group:Cold-blood cardioplegia was delivered retrogradely and intermittently through coronary sinus, and DVR was performed; (3)antegrade+retrograde perfusion group:The route of cold-blood cardioplegic infusion was antegrade during MVR procedure first and then retrograde during AVR procedure;and (4)beating heart group:Oxygenated blood from cardiopulmonary bypass machine was delivered retrogradely and continuously through coronary sinus, and DVR was performed with beating heart. Early clinical outcomes were observed. Serum cardiac troponin I (cTnI) was measured by enzyme-linked immunosorbent assay(ELISA). Serum creatine kinase-MB (CK-MB) and myocardial lactic acid release rate were measured by Hitachi7150 Automatic Chemistry Analyzer. Myocardial mitochondria malondialdehyde (MDA) level was measured through thiobarbituric acid reagent species analysis. Results All the 32 patients survived their surgery and were discharged successfully. Myocardial lactic acid release rate at 80 min after aortic cross-clamping, serum cTnI and CK-MB on the first postoperative day, myocardial mitochondria MDA levels of beating heart group were 13.59%±6.27%,(1.17±0.25) ng/ml, (56.43±16.50) U/L and(2.18±1.23) nmol/(ng.prot)respectively, all significantly lower than those of retrograde perfusion group [(33.49%±8.29%, (1.82±0.58 )ng/ml, (78.31±21.27) U/L (5.07±2.35) nmol/(ng.prot),P<0.05] and antegrade+retrograde perfusion group[20.87%±7.22%, (1.49±0.23) ng/ml,(66.67±19.13) U/L,(4.34±1.73) nmol/(ng.prot),P<0.05], but not statistically different from those of antegrade perfusion group [18.83%±5.97%, (1.41±0.32) ng/ml, (63.21±37.52) U/L, (3.46±1.62) nmol/ (ng.prot),P>0.05]. Conclusion All the four myocardial protective strategies are effective myocardial protection methods for DVR patients. Continuous retrograde perfusion with beating heart and intermittent antegrade perfusion can provide better myocardial protection, and therefore are preferred for DVR patients. The combination of antegrade and retrograde perfusion is easy to administer and does not negatively influence surgical procedures. Retrograde perfusion is also effective as it takes only a short time.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Comparison on Clinical Outcomes Between China-made CL-V Bileaflet Prosthesis and St. Jude Bileaflet Prosthesis

    Abstract: Objective To evaluate early clinical outcomes and short-term follow-up results of CL-V bileaflet prosthesis. Methods From April 2004 to May 2010, 38 patients with valvular heart diseases underwent mechanical heart valve replacement. Eighteen patients received CL-V bileaflet valve replacement (CL group) including 8 males and 10 females with their mean age of (47.4±6.2)years and mean body weight of (64.7±11.9) kg. Preoperatively,15 patients were in New York Heart Association (NYHA) classⅢ, and 2 patients were in NYHA classⅣ. Mitral valve replacement (MVR) was performed in 16 patients, mitral and aortic valve replacement(DVR) in 2 patients. A total of 20 CL-V bileaflet prostheses were implanted. Twenty patients received St. Jude bileaflet valve replacement (SJM group)including 9 males and 11 females with their mean age of (49.7±7.6) years and mean body weight of (66.1±11.1) kg. Preoperatively, 15 patients were in NYHA classⅢ, and 3 patients were in NYHA classⅣ. MVR was performed in 17 patients,aortic valve replacement (AVR) in 1 patient, and DVR in 2 patients. A total of 22 St. Jude bileaflet prostheses were implanted. Clinical outcomes, hear function, hemodynamics and blood compatibility were measured on the 7th postoperative day and 6 months during follow-up and compared between the two groups. Results There was no early mortality (<30 d) or postoperative complication in either group. Follow-up rate was 100% and the mean follow-up duration was 19.8 (6-61)months. At 6 months after surgery, those patients who were preoperatively in NYHA classⅢ orⅣall improved to classⅠ orⅡ. In CL group, cardiothoracic ratio was 0.51±0.05, left atrium diameter (44.5±7.8) mm, left ventricular end diastolic diameter (LVEDD,46.6±4.1) mm, LVEF 65.3%±7.7%,and LVFS 35.0%±7.1%. In SJM group, cardiothoracic ratio was 0.51±0.06, left atrium diameter (45.8±9.6) mm, LVEDD (46.2±9.8) mm, LVEF 64.1%±9.0%,and LVFS 34.9%±4.7%, which were not statistically different from those parameters of CL group respectively (P>0.05). At 6 months after surgery, transthoracic echocardiography was used to compare hemodynamics of bileaflet prostheses with same size 27 mm in the two groups. Prosthetic transvalvular gradient was (5.1±0.9)mm Hg in CL group and (5.8±0.8) mm Hg in SJM group, and effective orifice area was (2.3±0.3)cm2 in CL group and(2.5±0.2)cm2 in SJM group,which were not statistically significant between the two groups (P>0.05) respectively. In both groups, the level ofhemoglobin, lactate dehydrogenase and platelet at 6 months postoperatively were all within normal range and not statistically from those respective preoperative parameters(P>0.05). Hemolytic reaction and hemolytic anemia were not found. During early and short-term follow-up, there was no thromboembolic complications or anticoagulation-related severe bleeding events in the two groups with same anticoagulation intensity target (target INR value 1.5 to 2.5). Conclusion Early clinical outcomes and short-term follow-up results of CL-V bileaflet prostheses are similar to those of St. Jude bileaflet prostheses. Postoperative patients have good clinical outcomes, hemodynamics and blood compatibility. Patients’ heart function significantly improve during short-term follow-up without valve-related complication. Mid-term and Long-term follow-up are further needed to demonstrate its good performance.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 老年瓣膜病患者心瓣膜置换术的临床分析

    目的 总结老年瓣膜病患者行心瓣膜置换术的经验,以提高手术效果。 方法 回顾性分析2000年1月至2009年4月沈阳军区总医院收治74例老年瓣膜病患者行心瓣膜置换术的临床资料,其中男51例,女23例;年龄60~74岁。术前经心电图、胸部X线片、彩色超声心动图、主动脉根部造影和左心室选择性造影检查诊断,均经手术证实,单纯二尖瓣病变45例;单纯主动脉瓣病变13例,其中7例为先天性二叶主动脉瓣畸形导致退行性改变;主动脉瓣和二尖瓣联合病变16例。均在全身麻醉体外循环下行心瓣膜置换术。 结果 全组无手术死亡,围术期死亡2例。74例患者体外循环时间58.0~136.5 min,主动脉阻断时间36.0~102.0 min。生存患者均无明显并发症,术后9~32 d顺利出院。 结论 心瓣膜置换术是治疗老年瓣膜病的安全方法,对左心房增大者进行减容并对三尖瓣关闭不全者进行良好处理,可获得满意的临床效果。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 心瓣膜置换术后早期心肌顿抑致低心排血量综合征的诊治经验

    目的 探讨心瓣膜置换术后早期心肌顿抑的识别、诊断,以及由此导致严重低心排血量综合征(LCOS)的治疗方法,以提高诊断、治疗水平。 方法 回顾分析我科2004年9月至2006年9月期间4例心瓣膜置换术后早期出现心肌顿抑导致LCOS患者的临床资料,4例均为女性,年龄35~54岁,平均年龄46-75岁。术前左心室大小、收缩功能均基本正常,左心室舒张期末内径(LVEDD)3.5~6.3 cm,射血分数(EF)49%~61%;2例行二尖瓣、主动脉瓣置换术,1例行二尖瓣置换术,1例行主动脉瓣置换术。 结果 4例患者均在术后早期(14~40 h、平均26 h)出现无明确原因的LCOS,给予大剂量肾上腺素[0.10~0.15 μg/(min·kg)]治疗无效而改行主动脉内球囊反搏(IABP)治疗,4例患者IABP支持时间为7~12 d(平均8.5 d),3例痊愈,1例因肺部感染于术后28 d死于多器官功能衰竭。2例出现急性肾功能不全,1例7 d后肾功能恢复正常,1例经腹膜透析治疗2周后痊愈。 结论 心肌顿抑可出现在术前心功能良好,手术经过顺利的心瓣膜置换术患者,由心肌顿抑导致的术后早期LCOS,及时应用IABP可以减轻心脏负荷,增加冠状动脉灌注,改善重要脏器循环,有助于左心室渡过心肌顿抑期,恢复收缩功能,是成功救治的重要手段。

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • Fifteen Years Follow-up of 259 Patients of Mitral Valve Replacement with Chinesemade C-L Pugesturt Tilting Disc Mechanical Valve Prosthesis

    Abstract: Objective To evaluate the early and late results of mitral valve replacement with home made C-L pugesturt tilting disc and analyse the factors which impact on the therapeutic effect,so as to elevate the operative effect. Methods A retrospective study was made on the result of clinical data and longterm followup of 259 patients who had undergone the Chinesemade C-L pugesturt tilting disc mechanical valve replacement from October 1991 to November 2006. Results The data showed that there were 12 patients died in the duration of hospital stay.The hospital mortality was 4.63% (12/259).There were no mechanical valverelated complication in the earlier postoperative period.The mortality fell to 2.59% since 1996.Among the 235 patients,12 patients were lost during the followup,the rate of followup was 95.1%(235/247).The time for followup was 9.77±3.09 years. There were 26 late deaths.During the follow-up,death associated with the deterioration of valve structure were not observed. The 5 years, 10 years and l5 years survival rates were 86.80%±2.30%, 78.20%±3.33% and 55.23%±4.34% respectively; the thromboembolic event free rates for 5 years, 10 years and l5 years were 95.95%±0.74%, 92.52%±4.11% and 80.52%±4.11% respectively; the anticoagulant related bleeding free rates for 5 years, 10 years and l5 years were 94.64%±1.75%, 89.55%±3.28% and 79.39%±4.43% respectively.There were 141 patients(67.46%) in New York Heart Association(NYHA) classⅠ, 56 patients(26.79%) in class Ⅱ, 10 patients(4.78%) in class Ⅲ and 2 patients(0.95%) in class Ⅳ. Conclusion The results of follow-up for 15 years suggest that the Chinesemade C-L pugesturt tilting disc medical mechanical valve is a reliable and safe choice for mitral valve replacement.

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • Clinical Analysis of Surgical Treatment of NonIschemic Heart Valve Disease Combined with Coronary Artery Disease 

    Objective To summarize the outcomes and clinical features for surgical treatment of nonischemic heart valve disease(HVD) combined with coronary artery disease(CAD), so that to get better surgical result. Methods From January 2000 to June 2007, 105 patients with the mean age of 61.96±7.61 years (range 36-79 years), underwent the combined procedures.The etiology of HVD included: 59 rheumatic valve disease, 24 degenerative mitral lesion, 13 calcified aortic valve lesion, and 9 other aortic valve disease. CAD was preoperatively diagnosed by coronary arteriongraphy in 98 patients, and intraoperatively identified in 7 patients. Left ventricular ejection fraction was 50% or less in 45 patients. The total number of bypass grafts was 216 with the mean of 2.06 grafts per patient. Valve procedures included: 36 mitral valve valve replacement, 15 mitral repair,43 aortic valve replacement, 11 mitral valve and aortic valve replacement. Results There were 6 postoperative deaths with the mortality of 5.7%. The causes of death were 3 low cardiac output syndrome, 2 renal failure, and 1 heart arrest resulting in multiple organs failure. Ninety-three survivals were followed up from 1 month to 7 years, 6 patients were missed on follow-up. There were no late death. New York Heart Association class Ⅰ was observed in 25 patients, class Ⅱ53, class Ⅲ 10 and class Ⅳ 5. One patient still had existential chest pain. Conclusion There were no typical angina in majority of patients with nonischemic HVD combined with CAD, coronary arteriongraphy must be taken in patients with the age of 50 years and more, or with the risk factors for CAD.Intraoperative myocardial protection is very important because CAD further deteriorates myocardial dysfunction caused by HVD.The decreased left ventricular function is the important factor affecting the surgical results and it is hard to evaluate the underlying cause before the operation.

    Release date:2016-08-30 06:09 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
  • 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
  • Clinical Observation of Left Ventricular Remodeling after Valve Replacement for Valvular Heart Disease with Giant Left Ventricle

    Objective To evaluate the left ventricular remodeling after valve replacement for valvular heart disease with giant left ventricle. Methods The clinical material of 92 patients with valvular heart disease and giant left ventricle after valve replacement was retrospectively reviewed. The results of ultrosonic cardial gram(UCG) and the changes of cardiac function before and after operation were compared. Results There was no operative death. The value of left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), left atrial dimension (LAD), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), stroke volume (SV) and cardiothoracic ratio in 2 weeks and 2 months after operation were more decreased than those before operation(P〈0. 05). The value of LVEDD and LAD in 2 months after operation were much more decreased than those in 2 weeks after operation (P〈0. 05). The cardiac function in early stage after operation was more decreased than that before operation,but the cases of cardiac functional class Ⅱ (38 cases, 41.3% ) in 2 months after operation was significantly more than those before operation (5 cases, 5.4 % ). Conclusions The early effect of left ventricular remodeling is significant for valvular heart disease with giant left ventricle after valve replacement. The diameter of left ventricle and left atrial are significantly decreased after operation. The protection for cardiac function should be carefully taken in order to prevent the occurrence of complication after operation.

    Release date:2016-08-30 06:22 Export PDF Favorites Scan
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