ObjectiveTo explore clinical features and surgical strategies for patients with aortic dissection (AD) manifesting as pure aortic regurgitation (AR), avoid preoperative misdiagnosis, and provide reference for clinical diagnosis and treatment. MethodsClinical data of 5 AD patients who were preoperatively diagnosed as pure AR in Beijing Fu Wai Hospital from January 2005 to May 2012 were retrospectively analyzed. There were 4 male and 1 female patients with their median age of 41 (34-53) years. All the 5 patients were diagnosed as AD during the operation. One patient received aortic valvuloplasty, 1 patient received Wheat procedure, and 3 patients received Bentall procedure. Clinical manifestations, accessory examinations, intraoperative findings, surgical strategies and follow-up results were summarized. ResultsNo postoperative death or complication occurred in this study. Echocardiogram of patient 1 before discharge showed that transverse diameters of the ascending aorta and aortic sinus decreased with satisfactory closure of aortic valves but no AR. Echocardiogram and CT all showed normal function in mechanical valves and patent blood vessel prosthesis in the other 4 patients. All the 5 patients were followed up for 4 (1-5) years and were alive during follow-up. Echocardiogram showed normal function in mechanical valves and patent blood vessel prosthesis without paravalvular leak in 4 patients and mild AR in 1 patient. ConclusionAD manifesting as pure AR is rare and easily misdiagnosed preoperatively. Careful analysis of medical history and accessory examinations can reduce the risk of misdiagnosis. Appropriate surgical strategies should be chosen according to intraoperative findings of intimal tears and aortic sinus damage of AD.
ObjectiveTo examine the cause of failure of mitral valve repair. MethodWe retrospectively anal-yzed the clinical data of 89 consecutive patients with non-rheumatic mitral valve diseases who underwent reoperation for failure of mitral valve repair in our hospital from January 2009 through January 2016. There were 54 males and 35 females at age of 36.2±17.4 years. ResultsThere were 16 patients with reoperation of mitral valve repairs and 73 patients of mitral valve replacements. The failure reasons of initial mitral valve repair were technique-related in 63 patients (70.8%) and valve-related in 18 patients (20.2%). Technique-related causes of repair failure included leaflet suture dehiscence (20 patients, 22.5%), edge-to-edge procedure (11 patients, 12.4%), leaflet thickening or retraction (11 patients, 12.4%), ring dehiscence (8 patients, 9.0%), inappropriate annuloplasty (6 patients, 6.7%), incomplete repair (4 patients, 4.5%), and chordal elongation or rupture (3 patients, 3.4%). Median interval since previous repair was 4.0 (0.04-18.0) years for the technique-related failure group, and 9.7 (0.21-35.6) years for valve-related failure group (P < 0.05). ConclusionTechnique-related factors are main causes of repair failure, which include leaflet suture dehiscence, edge-to-edge procedure, and leaflet thickening or retraction. Reoperation for technique-related failure needs to be adopted early.