Objective To investigate the feasibility and effect of stentedpulmonary autograft replacement and find out the best way to treat mitral valve diseases. Methods From August 2006 to October 2007, 20 male sheep at the age of about 1 year old underwent mitral valves replacement operation in Anzhen Hospital. Weight of these sheep was 50.0±6.0 kg. They were randomly divided into two groups. Ten sheep in the experimental group underwent RossⅡsurgery in which we first sutured pulmonary valve onto a pulmonary valve stent, transferred the valve to the mitral valve annulus and then reestablished the outflow tract of the right ventricle. The other 10 sheep in the control group underwent bioprosthetic valve replacement routinely. Ultrasonic cardiogram (UCG) was employed 6 hour after operation to measure the effective orifice area (EOA) of the mitral valve, mitral peak velocity of early filling, the peak pressure gradient (PPG), the extent of regurgitation, left ventricular enddiastolic dimension (LVEDD) and ejection fraction (EF). Results One sheep in the experimental group died of low cardiac output syndrome; one in the control group died of unmanageable bleeding during operation, and the others all survived. Six hours after operation, UCG of the experimental group showed that the heart valves were well fixed, valve echo was clear, and there was no perivalvular leakage or mitral valve stricture or regurgitation, but moderate pulmonary valve regurgitation occurred in 1 case and mild in 2. There was no significant difference between the two groups in PPG (11.86±1.28 mm Hg vs. 10.98±0.98 mm Hg,t= 1.670,P=0.110) and the mitral peak velocity of early filling (1.72±0.09 m/s vs. 1.65±0.07 m/s, t=1.680,P=0.110). However, EOA of the experimental group was smaller than the control group (2.23±0.09 cm2 vs. 2.39±0.08 cm2, t= 4.240,P= 0.001). Conclusion The experimental result of sheep mitral valves replacement with stentedpulmonary autograft is satisfying. The new mitral valves work well and the surgery method is feasible.
Objective To summarize the experience and results of mitral annuloplasty with modified partial flexible artificial ring. Methods Two hundred and fifteennine patients were underwent partial flexible ring annuloplasty after mitral valve plasty surgery in our hospital from an. 1998 to Aug.2006. The etiology included rheumatic (16 cases), infective endocarditis of mitral (16 cases), ischemic (13 cases), ongenital (40 cases) and degeneration (174 cases). Echocardiogram test were performed in the perioperative periods to monitor the lefe atrium (LA), left ventricular enddiastolic dimension (LVEDD), left ventricular endsystolic dimension (LVESD), left ventricular ejection fraction(LVEF), left ventricular fractional shortening (LVFS) and mitral regurgitation grades. The perioperative mortality, morbidity, reoperation rate were recorded during the followup. Results Aortic cross clamping time was 74±30 min and cardiopulmonary bypass time was 105±37min. The perioperative survival rate was 96.5% (250/259) and free from complications rate was 93.4% （242/259）. No left ventricular out flow tract obstruction and coronary artery stenosis were occurred in this group. The 60 months survival rate was 938% (243/259) and 5 years nonreoperation rate was 96.1%(249/259). The perioperative echocardiogram results showed the LVEDD decreased from 62.60±10.19mm to 52.88±8.67mm and the LVEF increased from 57.91% to 61.00%（Plt;0.05）. During the followup the mitral regurgitation grades were improved significantly (Plt;0.05),there were 188 cases of trifle mitral regurgitation (72.6%), 62 cases of mild mitral regurgitation (23.9%), 8 cases of moderate mitral regurgitation(3.1%) and 1 case of serious mitral regurgitation(0.4%). Conclusion This simplified mitral annuloplasty technique is an easy handling and effective treatment for the mitral repair.
Objective To report the preliminary results of intraoperative saline-irrigated radiofrequency modified maze procedure for chronic atrial fibrillation (AF) in mitral valve diseases. Methods From May 2003 to April 2004 forty-one patients underwent intraoperative saline-irrigated modified maze procedure. The patients included 13 male and 28 female. Their age ranged from 27-65 years (46±10 years). The duration of AF varied from 5 months to 15 years (4.5±3.6 years).The left atrial diameter varied from 37-93 mm (54±11mm). There were mitral stenosis 20, mitral regurgitation 1 and mitral stenosis with regurgitation 20 cases. Cardiopulmonary bypass (CPB) was established as usual. Ablation lines were made with Cardioblate (Medtronic, 25-30 W, 180-240ml/h). Having finished right-sided maze procedure, the aorta was cross-clamped and cold crystalloid or blood cardioplegia were used for myocardial protection. Left atrial incision was performed through the interatrial groove. The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively. The ablation lines were also performed from the left encircling line to the posterior mitral valvular annulus and to the orifice of left atrial appendage respectively. A ablation line was used to connect left and right pulmonary veins circumferential line. Concomitant procedures were performed (there were double valve replacement 10 cases, mitral valve replacement 31 cases, tricuspid annuloplasty 6 cases, removing the left atrial thrombi 6 cases). Results CPB time varied from 71-160 min (105±24 min) and cross-clamping time varied from 32-106 min (62±20 min). The ablation time varied from 4-22 min (11±4 min). One patient died during hospitalization and the death was caused by acute mechanic valve obstruction. During follow-up at discharge and 3 months 35% patients (14/40) were free of AF and the others were not. But at 6 months 67% patients (10/15) were free of AF. Conclusion The intraoperative saline-irrigated radiofrequency modified maze procedure is comparatively simpler and its efficacy is satisfactory.
Objective To estimate the degree of the angle between left principal bronchus and trachea, and it is correlative with the pulmonary function in the patients with rheumatic mitral valve disease. Methods According to various degree of angles between left principal bronchus and trachea,53 patients were divided into three groups, group 1: angle between left principal bronchus and trachea less than 50 degree, group 2: between 50 and 64 degree, group 3: between 65 and 79 degree. The pulmonary function tests,ultrasonic cardiography and left principal bronchus X-ray tomographic film were carried out in three groups before operation. Compare pulmonary function data with different angle between left principal bronchus and trachea in three groups. Results Exception of vital capacity ,residual volume and total lung capacity,the rest markers of lung function showed significant differences (Plt;0.05) in three groups. The correlation of the angle between left principal bronchus and trachea and the ratio of residual volume and total lung capacity among three groups were positively correlative, and the other parameters of lung function were negatively correlative (Plt;0.01). Conclusion The degree of the angle between left principal bronchus and trachea is positively correlative with the extent of pulmonary function impairing.
ObjectiveTo observe the changes of left atrial geometry before and after mitral valve replacement in patients with different types of mitral valve disease and different heart rhythm, and to identify factors determining left atrial remodeling after mitral valve replacement. MethodsA total of 215 consecutive patients of mitral valve replacement in Department of Thoracic and Cardiovascular Surgery of West China Hospital, Sichuan University from January 2003 to March 2008 were selected and followed up for this study. There were 52 male and 163 female patients with their age of 40.58±10.54 years (ranged, 18-67 years). St. Jude Medical mechanical valves were used. According to the type of mitral valve diseases (mitral stenosis (MS) or mitral regurgitation (MR)) and heart rhythm (atrial fibrillation (AF) or sinus rhythm (SR)), patients were divided into 4 groups. There were 54 patients with MS and SR (including 13 male and 41 female patients with their age of 39.31±9.46 years), 56 patients with MS and AF (including 14 male and 42 female patients with their age of 41.12±10.72 years), 52 patients with MR and SR (including 12 male and 40 female patients with their age of 39.71±10.09 years), 53 patients with MR and AF (including 13 male and 40 female patients with their age of 40.19±11.87 years). All patients had routine examinations and echocardiogram preoperatively and two years after surgery. Left atrial anteroposterior diameter (LAD), left atrial area (LAA), left atrial volume (LAV) and left atrial volume index (LAVi) were used to analyze the changes of left atrial geometry. ResultsThere was no in-hospital death. Major postoperative complications included low cardiac output syndrome in 5 patients, pneumonia in 6 patients. LAVi were lower in mitral stenosis patients than that in mitral regurgitation patients (P<0.05), LAVi were lower in patients with sinus rhythm than that in patients with atrial fibrillation (P<0.05). Two years after mitral valve replacement, the extent of left atrial reverse remodeling were significantly greater in mitral regurgitation patients than in mitral stenosis patients (P<0.05), and the extent of left atrial reverse remodeling were significantly greater in patients with sinus rhythm than that in patients with atrial fibrillation (P<0.05). ConclusionsAge, atrial fibrillation, preoperative left atrial volume, mitral regurgitation, left ventricle end-diastolic diameter are important influencing factors of left atrial reverse remodeling after mitral valve replacement.