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 investigate the cl inical effect of vacuum seal ing drainage (VSD) on late-stage large skin avulsion injury with infection. Methods From May 2007 to August 2008, 9 patients with large-area skin avulsion injury and infection were treated. There were 1 male and 8 females aged 9-52 years old (median 27 years old). All patients suffered from closed skin avulsion injury involving the lower back, buttock, and part of the thigh. The injury area varied from 30 cm × 25 cm to92 cm × 38 cm. The time between injury and hospital admission was 15-23 days. The skin avulsion injury was compl icated with pelvis fracture, urethral injury, anal injury, sacrum exposure, and l imb fractures. The interval between hospital admission and operation was 3-23 hours. Free spl it-thickness skin graft was performed after the focus debridement and three VSD treatments (40-60 kPa). Results After three VSD treatments, no patient had general pyemia and severe local tissue necrosis or infection, the tissue edema in the skin avulsion area was alleviated obviously, and all the wound cavities were closed. All the wounds in the graft site healed after 28-45 days of treatment (average 39 days), and all the donor sites healed. Nine patients were followed up for 4-14 months (average 10 months). The appearance of the reparative area was good, and there was no occurrence of joint dysfunction in the injured area due to scar contracture. Conclusion VSD is effective in treating late-stage large skin avulsion injury with infection.
Objective To compare long-term outcomes following mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for native valve endocarditis (NVE). Methods Between November 1993 and August 2016, consecutive 101 patients with NVE underwent mitral surgery in our department, MVP for 52 patients and MVR for 49 patients. There were 69 males and 32 females at age of 38.1±14.9 years. The mean follow-up was 99.4±75.8 months. Results There was no statistical difference in cardiopulmonary bypass time, aortic cross-clamp time, in-hospital mortality, duration of mechanical ventilation, ICU stay or hospital stay after surgery between the two groups. Survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 97.6%, 97.6% for MVP, and 93.5%, 84.3%, 84.3%, 66.2% for MVR with a statistical difference between the two groups (P=0.018). There was no stroke in the patients with MVP during follow-up periods. However, stroke-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 93.9%, 89.4%, 70.2% for MVR patients with a statistical difference between the two groups (P=0.023). There was no statistical difference in recurrence of infection, perivalvular leakage and reoperation between the two groups. Composite endpoint-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 92.9%, 92.9% for MVP, and 91.3%, 79.6%, 75.8%, 51.0% for MVR with a statistical difference (P=0.006). Conclusion MVP is associated with better outcomes than MVR in the patients with NVE; generalizing MVP technique in the patients with NVE is needed.