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三尖瓣置换术治疗Ebstein畸形合并巨大心脏一例

心脏病合并甲状腺功能减退症患者的外科治疗

目的 总结心脏病合并甲状腺功能减退症患者行外科手术治疗的临床经验。 方法 回顾性分析2001年9月至2009年5月解放军总医院19例心脏病合并甲状腺功能减退症患者行外科手术治疗的临床资料，男7例，女12例；年龄50～76岁，平均年龄63.20岁。冠心病15例，主动脉瓣狭窄1例，房间隔缺损1例，慢性心包炎2例；均合并甲状腺功能减退症。所有患者术前给予左旋甲状腺素钠（40~120 mg/d）口服治疗，根据其耐受程度、促甲状腺激素和甲状腺激素水平调整用量，将甲状腺激素水平调整至基本正常。行体外循环冠状动脉旁路移植术6例，非体外循环冠状动脉旁路移植术9例，房间隔缺损修补术1例，主动脉瓣置换术1例，心包剥脱术2例。术后按原剂量或加量口服左旋甲状腺素钠片，检测手术前、后甲状腺激素指标的改变。 结果 无手术死亡，术后所有患者均未发生低三碘甲状腺原氨酸（T3）综合征，甲状腺功能指标与术前比较均有不同程度的降低，以血清总三碘甲状腺原氨酸和血清游离三碘甲状腺原氨酸降低最为明显，体外循环手术患者下降幅度更大。术后继续给予甲状腺素钠口服，并持续服用维持量的甲状腺素钠。随访19例，随访时间4～7个月，随访期间均持续服用维持量的甲状腺素钠，心功能分级（NYHA）Ⅰ级14例，Ⅱ级5例；患者恢复正常生活。 结论 合并甲状腺功能减退症的心脏病患者行心脏手术是安全、可行的，体外循环和非体外循环心脏手术后甲状腺激素均有所降低，体外循环手术患者下降更明显，术后应警惕发生低T3综合征和低T3、T4综合征。

人工心脏瓣膜置换术后血栓性瓣膜功能障碍的治疗

Surgical Treatment and Clinical Diagnosis of Infective Endocarditis: Report of 60 Cases

Abstract： Objective To summarize the clinical diagnostic and therapeutic experiences of infective endocarditis (IE). Methods From Jan. 2000 to Aug. 2006，60 IE patients underwent heart operation in PLA General Hospital. There were 46 male and 14 female patients, with an average age of 34.3 years old. Blood culture was positive in 25 cases (41.7%), Streptococcus was found in 12 cases, Staphylococcus in 6 cases and other bacteria in 7 cases. Ultrasonic cardiography(UCG) revealed vegetations or valve perforation in 42 cases, including 26 aortic valves, 9 mitral valves and 6 double valves. 28 cases had primary cardiac diseases，including 16 cases of congenital heart anomalies，9 cases of rheumatic heart disease and 3 cases of mitral valve prolapse. High dose of sensitive antibiotics were utilized all through the treatment in all IE patients. There were 55 selective surgeries and 5 emergent ones. Infected tissues were debrided radically，intracardiac malformation was corrected in 16 cases, valve replacement was performed in 41 cases, tricuspid plasty in 1 case. Results There were 3 patients of earlydeath. 51 patients(89.5%) were followedup for 5-71 months with norecurrence. Postoperative cardiac function (NYHA): class I was in 38 cases, class II in 13 cases. Conclusion Early diagnosis, optimal surgical timing, combined internal medicine and surgical treatment provided good therapeutic effect of IE.

Coronary artery bypass grafting for patients older than 70

Objective To introduce the results and strategy of perioperative management undergo coronary artery bypass grafting (CABG) for patients older than 70. Methods One hundred and twenty one patients, 93.4%(113/121) of whom was complicated with other diseases, were retrospectively studied. Off-pump CABG (OPCAB) was used in 80 cases (66.1%). For the rest patients with severely compromised heart function or small target vessel with diffuse lesion, conventional CABG (CCABG) was selected. Left internal mammary artery (LIMA) was harvested leaving pleural cavity intact and grafted to left anterior descending artery (LAD). Saphenous vein(SV) was utilized for other anastomoses. Transit-time flowmeter (TTFM) was utilized to make sure that grafts were patent with satisfactory blood flow. Procedure of sternotomy and chest closure was carefully performed to decrease the complication of mediastinitis. Adequate nutrition and gradually increased physical activity were encouraged for "fast-track". Results Grafts were 3.08±0.75 for CCABG and 2.24±0.82 for OPCAB . LIMA was used in 90.9%(110/121) patients. One patient receiving emergency operation died of multiple organ failure syndrome resulting in mortality of 0.8%. The incidence of complication was 3.3%(4/121). The others recovered smoothly without any complication. Intubation time of OPCAB(10.04±5.68 h) was significantly shorter than that of CCABG(21.46±14.54 h). Patients were discharged within 12.22±5.56 days after operation. Conclusion Good short term result, namely low incidence of mortality and complication, could be obtained in patients older than 70 who underwent CABG through meticulous perioperative management.

Mean flow in internal mammary artery graft and its influencing factors in the Chinese

Objective To analyze the mean flow in left internal m am mary artery ( L IMA) graft and the influencing factors in off- pump coronary artery bypass grafting ( OPCAB) in the Chinese. Methods One hundred and eighty patients with OPCAB were studied.Transit- tim e flowmeter( TTFM) was utilized to measure and record the L IMA’s blood flow wave,pulsatility index( PI) ,value of mean flow,systolic and diastolic peak flow,vascular resistance,insufficiency ratio and mean blood pressure and to analyze the relationship between mean flow of LIMA and other factors. Results Total mean flow calculated from that of all patients was2 8.19± 2 .89ml/ min( 6 - 178 ml/ m in) .Majority m ean value ( 6 4 .4 % ) was in the range of 10 - 30 ml/ min.Statistics showed that mean flow was significantly related to systolic and diastolic peak flow and vascular resistance rather than the other factors( r=0 .75 , 0 .94 ,- 0 .95 ) . Conclusions For the Chinese,over 10 ml/ min mean flow of L IMA graftis acceptable and ov...更多er 2 2 ml/ min is satisfactory.The diastolic peak flow and vascular resistance are two most important factors in influencing mean flow.

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.