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find Author "陆方林" 13 results
  • Development of transcatheter intervention devices for tricuspid valve lesions

    Recently, several transcatheter devices for aortic valve replacement and mitral valve repair have been used in clinic, and researchers have designed a variety of tricuspid valve (TV) intervention devices. We reviewed the current status of transcatheter TV intervention, and focused on the structures of these devices and the early results of clinical trials. Undoubtedly, transcatheter intervention for TV is promising, innovational and safe for patients with severe TV regurgitation.

    Release date:2018-03-28 03:22 Export PDF Favorites Scan
  • Establishment of tricuspid regurgitation via right anterior-lateral minimal incision in goats model

    ObjectiveTo explore the feasibility of goat tricuspid regurgitation (TR) model by one chordae tendineae cutter via right anterior-lateral minimal incision.MethodsTR model was established in 6 goats with a self-made tricuspid valve chordae tendineae cutter. The goats were placed in a left lateral position and procedure was performed via a right anterior-lateral minimal thoracotomy in the fourth intercostal. Under the guidance of transesophageal ultrasound and digital subtraction angiography, the chordae tendineae of anterior leaflet was cut until moderate to severe regurgitation was confirmed. Echocardiography and laboratory examinations were performed preoperatively, immediately and 3 months after surgery. Additionally, all goats were sacrificed to clarify pathological evaluation.ResultsTR was successfully established in 6 goats. The right atrium pressure increased significantly immediately after surgery (P<0.05). During a follow-up of 3 months, the progression of TR was aggravated (P<0.05), and the annular diameter increased from 2.15±0.23 cm to 2.65±0.20 cm. Overall, there was no statistically significant change in transvalvular gradient and velocity between preoperation and postoperation. Laboratory test results showed no abnormalities between preoperation and postoperation. Autopsy evaluation demonstrated obvioue chordae tendineae transection of the anterior leaflet.ConclusionIt is feasible to establish TR model via a right minimal anterior lateral thoracotomy in the fourth intercostal space. This novel TR goats model will allow investigation of transcatheter interventional device and serve as a chronic model in the future.

    Release date:2019-10-12 01:36 Export PDF Favorites Scan
  • Current status of transcatheter tricuspid valve intervention treatment

    In historic perspectives, tricuspid valve was considered as “forgotten valve” in the cardiovascular field. Tricuspid regurgitation (TR) is the main disease of the tricuspid valve, and the number of patients is large. TR patients have mostly treated conservatively with drugs due to high surgical mortality, so the effective treatment of TR patients is far from satisfactory. With the development of interventional technology, transcatheter tricuspid valve intervention (TTVI) is expected to become a better choice. In recent years, a number of TTVI devices have entered clinical trials and achieved good results. Due to the late development of TTVI technology and insufficient accumulation of clinical applications, there are no uniform inclusion criteria and evaluation indicators for research endpoints when conducting clinical trials. This article focuses on the introduction of different instruments of TTVI, and summarizes the current status, research progress and problems of these treatments.

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  • Results and Methods of Aortic Root Replacement for the Patients with Severe Aortic Valve Infective Endocarditis

    Objective To improve the surgical results of infective endocarditis, the results and methods of aortic root replacement in patients with severe aortic valve infective or prosthetic valve endocarditis were summarized. Methods From Sept.1995 to June 2008, there were 11 patients with severe aortic valve endocarditis treated surgically, included 6 active endocarditis and 5 healed endocarditis. Preoperative arterial blood bacterial culture were positive in 6 patients. Preoperative echocardiography showed all patients had various degree of aortic regurgitation or paraprosthetic leakage, left ventricular endsystolic diameter(LVESD) was 6.0±0.7cm, LVESD was equal or greater than 5.5cm in 7 patients, left ventricular ejection fraction (LVEF) was 47.8%±11.2%, and LVEF was equal or less than 50% in 8 patients. After careful debridement, composite conduit (9 patients) or cryopreserved allograft (2 patients) was used to replace the aortic root. Concomitant procedures were coronary artery bypass grafting in 4 patients, mitral annuloplasty in 3 patients, and ventricular septal defect repair in 1 patient. Results There was one patient died of postoperative cardiac arrest, one patient had Ⅲ° atrioventricular block and pacemaker implanted. Ten patients were followed up, followup time were from 3 months to 13.2 years. During the followup period, one patient had recurrence of endocarditis and died, others survived uneventually. Conclusion Aortic root replacement must be considered in following patients: endocarditis combined with root aneurysm or sinus aneurysm, infectious disease involved in sinus wall or nearby coronary ostia, annulus impairment and severe destructive annulus after debridement. The key points of the surgery are debriding the infectious tissue completely, preventing aortic root bleeding. Although the root replacement is relatively complex, the surgical results could be improved after complete debridement of infectious tissue.

    Release date:2016-08-30 06:05 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
  • Clinical Analysis of Repeated Heart Valve Surgery in 325 Patients

    Abstract: Objective To summarize surgical experiences and explore risk factors of patients undergoing repeated heart valve surgery. Methods Clinical records of 325 consecutive patients who underwent repeated heart valve surgery from January 1998 to December 2008 in Changhai Hospital of Second Military Medical University were retrospectively  analyzed. There were 149 male patients and 176 female patients with their average age of (47.1±11.8) years. Following  variables were collected: preoperative morbidity, heart function, indications and surgical strategies of repeated heart valve surgery, postoperative mortality and morbidity, which were compared with those clinical data of patients who underwent their first heart valve surgery during the same period. Multivariate logistic regression was used to determine risk factors of perioperative death of patients undergoing repeated heart valve surgery. Results The main reasons for repeated heart valve surgery were mitral valve restenosis after closed mitral commissurotomy and new other valvular diseases. Postoperatively, 28 patients died in the early-stage with the overall mortality of 8.6% (28/325). The main reasons of in-hospital death included low cardiac output syndrome (LCOS)and acute renal failure. Compared with patients undergoing their first heart valve surgery, patients who underwent repeated heart valve surgery were more likely to have chronic obstructive  pulmonary disease (COPD), New York Heart Association (NYHA) classⅢ-Ⅳ, and atrial fibrillation, preoperatively. Their cardiopulmonary bypass time and aortic cross clamp time were comparatively longer. They also had more postoperative  morbidities such as LCOS, acute renal failure and acute respiratory distress syndrome (ARDS). Multivariate logistic regression showed that preoperative critical state (OR=2.82, P=0.002), cardiopulmonary bypass time longer than 120 minutes (OR=1.13, P=0.008), concomitant coronary artery bypass grafting (OR=1.64, P=0.005), postoperative LCOS(OR=4.52, P<0.001), ARDS (OR=3.11, P<0.001) and acute renal failure (OR=4.13, P<0.001)were independent risk factors of perioperative death of patients undergoing repeated heart valve surgery. Conclusion Repeated heart valve surgery is a difficult surgical procedure with comparatively higher risks. Full preoperative assessment of the valvular lesions,  proper timing for surgery and perioperative management are helpful to reduce postoperative mortality and morbidity.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Influence of Preoperative Atrial Fibrillation on Midterm and Longterm Outcomes of Patients after Mitral Valve Replacement

    Abstract: Objective To determine the influence of preoperative atrial fibrillation (AF) on midterm and longterm clinical outcomes of patients after mitral valve replacement (MVR). Methods We retrospectively analyzed clinical data of 1 029 patients who underwent MVR with or without tricuspid valve repair in Changhai Hospital, Second Military Medical University, from January 2000 to December 2005. According to the exclusion criteria, 621 patients were selected and divided into two groups depending on presence of preoperative AF. Those 395 patients with preoperative AF belonged to the AF group, including 134 males and 261 females with their average age of 51.1±11.5 years. Those 226 patients with preoperative sinus rhythm (SR) were in the SR group, including 82 males and 144 females with their average age of 48.2±14.1 years. Early postoperative outcomes, midterm and longterm mortality and morbidity of the two groups were compared. Results During 10 years of follow-up, there was no statistical difference in early postoperative mortality and morbidity between the two groups, but the incidence of late thromboembolism was significantly higher in AF group than that in SR group [0.9‰ (31 patients/33 984 patient-months) vs. 0.4‰ (9 patients/21 151 patient-months), χ2=4.26, P=0.039]. Ten-year survival rate in patients in AF group was significantly lower than that in SR group (83.2% vs. 92.7%, χ2=10.26, P=0.002). Multivariate analysis identified preoperative AF [HR=2.878, 95% CI (1.166,4.129)], low left ventricular ejection fraction [HR=0.948, 95% CI (0.917,0.981)] , and old age [HR=1.073, 95% CI (1.038,1.109)] as independent risk factors for late mortality after MVR. Apart from its influence on patient survival rate and incidence of thromboembolism, preoperative AF also had an adverse effect on left ventricular function, right ventricular function and tricuspid regurgitation. Conclusion AF is an independent risk factor for poor prognosis after MVR. Prognosis after MVR might be improved if surgery could be performed early when patients have predictive signs of AF such as multiple premature atrial contractions or left atrium enlargement.

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • Clinical Outcomes of Aortic valve Replacement for Surgical Treatment of Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction

    ObjectiveTo investigate clinical outcomes of aortic valve replacement (AVR)for surgical treatment of patients with severe aortic stenosis (AS)and left ventricular dysfunction (LVD). MethodsClinical data of 29 patients with severe AS and LVD (left ventricular ejection fraction (LVEF) < 0.50)who underwent AVR in Changhai Hospital between January 2000 and December 2011 were retrospectively analyzed. Patients with mitral stenosis were excluded from this study. There were 22 male and 7 female patients with their age of 14-76 (56.3±12.9)years. Preoperative and postoperative clinical and echocardiographic findings were compared to assess AVR effects. Possible risk factors affecting postoperative recovery of left ventricular function were analyzed according to postoperative LVEF changes. ResultsOne patient died within 30 days after AVR. In the other 28 patients, postoperative aortic pressure gradient (APG)decreased from 97.6±25.1 mm Hg to 25.0±9.7 mm Hg, while LVEF increased from 41%±6% to 56%±11%. Postoperative left ventricular end-diastolic/systolic diameter/volume all significantly improved (all P < 0.001). ConclusionsAVR is an effective treatment for patients with severe AS and LVD. Left ventricular function improves significantly in most patients after AVR. Patients with a less dilated left ventricle may have a better LVEF recovery.

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  • Transcatheter tricuspid valve replacement for severe tricuspid regurgitation: a case report and literature review

    ObjectiveTo explore the clinical effect of LuX-Valve implantation in patients with severe tricuspid regurgitation (TR) and review articles about similar devices.MethodsWe reported the data of a 58-year-old male patient with severe TR, who was hospitalized on March 17th, 2020 because of “abdominal distention and edema for 5 years”, and then received LuX-Valve implantation in the Department of Cardiovascular Surgery of Changhai Hospital, Naval Medical University. Articles about transcatheter tricuspid valve replacement were reviewed in PubMed according to the key words including “transcatheter tricuspid valve replacement” “TTVR” and “transcatheter tricuspid valve intervention”.ResultsThe patient with severe TR received LuX-Valve implantation under general anesthesia and the guidance of digital subtraction angiography and transesophageal echocardiography. The patient’s TR was totally corrected after implantation and postoperative one-month follow-up showed well clinical effects. The result of literature review showed that there were two similar devices and both had been implanted in TR patients.ConclusionLuX-Valve is an effective and reliable transcatheter tricuspid valve replacement device.

    Release date:2020-10-26 03:00 Export PDF Favorites Scan
  • Clinical treatment of acute aortic dissection in late pregnancy and puerperium

    Objective To study the clinical characteristics, therapy strategies and the outcomes of female patients with acute aortic dissection during late pregnancy and puerperal period. Methods We retrospectively analyzed the clinical data of 7 patients with acute aortic dissection during late pregnancy and puerperal period in Shanghai Changhai Hospital between August 2012 and June 2017. Five of the 7 patients were late stage pregnancy, 2 were puerperal period (1 at the postpartum night, 1 in 18 days after delivery). There were 6 patients of Stanford type A aortic dissection (85.7%), and 1 patient of type B aortic dissection (14.3%). The age of the patients ranged from 26 to 34 (30.8±3.1) years. Cardiac ultrasonography of patients with type A showed that the maximum diameter of the ascending aortas was 4.2–5.7 (4.7±0.6) cm, of which 2 patients were aneurysm of aortic sinus, 3 patients were with Marfan syndrome. Bentall procedure was conducted in 1 patient, Bentall+Sun’s surgery in 2 patients, ascending aorta replacement+Sun’s+coronary artery bypass grafting surgery in 1 patient, aortic root remodeling+ascending aorta replacement+Sun’s surgery in 2 patients. One patient with Stanford type B acute aortic dissection was performed with thoracic endovascular aortic repair (TEVAR) after cesarean section. Results Aortic blocking time ranged from 51 to 129 (85.5±22.9) min. Cardiopulmonary bypass time was 75–196 (159.0±44.0) min. Moderate hypothermic circulation arrest with selective cerebral perfusion time was 20–30 (23.8±3.5) min. All maternal and fetuses survived. The infant whose mother received aortic repair in early stage and then received cesarean section was diagnosed with cerebral palsy. Maternal and fetuses were followed up for 9 months to 4 years. During the follow up period, all the fetuses grew well except the cerebral palsy one, and all maternal recovered well. The patient who received aortic repair in the early stage, had a sigmoid rupture during cesarean section and was treated with sigmoid colostomy. Another patient with Stanford type A dissection was diagnosed as left renal vein entrapment syndrome after 2 years. Conclusion Type A aortic dissection is more common in late pregnancy and puerperal patients. And Marfan syndrome is a high-risk factor for acute aortic dissection in pregnancy women. Early and appropriate surgical treatment strategy based on the type of aortic dissection and gestational age are the key points to achieve good outcomes both for maternal and fetus.

    Release date:2018-07-27 02:40 Export PDF Favorites Scan
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