ObjectiveTo investigate the clinical characteristic differences of cementless total hip arthroplasty (THA) between with and without subtrochanteric femoral shortening osteostomy in Crowe type IV developmental dysplasia of the hip (DDH). MethodsBetween January 2006 and March 2012, 21 patients (21 hips) with Crowe type IV DDH who underwent primary THA were enrolled according to inclusion criteria. According to whether subtrochanteric femoral shortening osteostomy was performed during THA or not, the patients were divided into 2 groups: THA with osteostomy group (n=9) and THA without osteotomy group (n=12). There was no significant difference in gender, age, body mass index, and hip Harris score between 2 groups (P>0.05) except leg length discrepancy (t=-3.170, P=0.005). The operation time, blood loss, postoperative drainage, complications, and radiography data were compared to evaluate the clinical characteristics. ResultsThe operation time, blood loss, and postoperative drainage of osteotomy group were all significantly greater than those of no osteotomy group (P<0.05). All patients achieved primary healing of incision; 1 patient (1 hip) had transient sciatic nerve symptom in osteotomy group. The average follow-up time was 53 months (range, 28-88 months). The X-ray films showed good fracture healing at 3-6 months after operation in osteostomy group. No prosthetic loosening or dislocation was found. The hip Harris score was 90.67±4.06 in osteostomy group and 92.17±3.27 in no osteostomy group, showing no significant difference between 2 groups (t=-0.938, P=0.360). The leg length discrepancy was (0.22±0.26) cm in osteostomy group and (0.18±0.27) cm in no osteostomy group, showing no significant difference (t=107.000, P=0.546). The leg length discrepancy was found in 6 patients of osteotomy group and 5 patients of no osteotomy group. One patient complained of thigh pain in osteotomy group; 2 patients had slight limp (Trendelenburg +) in no osteotomy group. ConclusionTHA can improve joint function and increase limb length in the treatment of Crowe type IV DDH. Subtrochanteric shortening osteotomy is an effective treatment which can be performed according to preoperative template measurement, leg length shortening, and the soft tissue tension.
Objective To discuss the endothelial cell which was modified by exogenous anticoagulant genes contribute to the increase of antithrombosis activity of lined vascular prosthesis and the influence to other physiological functions of endothelial cells. Methods This summarized paper was made on literature review of recent years. Results The transfection of genes, including plasminogen activator (tPA, uPA, Urokinase), thrombomoduline (TM) and hirudin, etc, to endothelial cells resulted in not only the increase of antithrombosis activity of local vascular, but also the decrease of endothelial cell function in adherence and proliferation. Conclusion The increase of antithrombosis activity of lined vascular prosthesis has been done by exogenous genes. However, this technique ought to be studied, intensively.
Abstract： Objective To investigate the early and mid-term outcomes of morphologic tricuspid valve replacement by means of intravalvular implantation in corrected transposition of great arteries（cTGA）. Methods From January 2009 to January 2012，11 patients with cTGA were surgically treated in Fu Wai Hospital. There were 9 male patients and 2 female patients with their mean of age of（37.8±11.7）years and mean body weight of（73.0±11.3）kg. All the patients underwent morphologic tricuspid valve replacement with preservation of the entire valvular and subvalvular apparatus. Simultaneous surgical procedures included repair of ventricular septal defect in 2 patients，repair of atrial septal defect in 4 patients，pulmonary valvuloplasty in 1 patient，reconstruction of functional right ventricular outflow tract in 4 patients and repair of coronary-pulmonary artery fistula in 1 patient. Postoperative New York Heart Association （NYHA） classification, cardiothoracic ratio, morphological right ventricle ejection fraction, end-diastolic dimension of morphological right ventricle and left atrium were evaluated during follow-up. Results All the 11 patients were successfully surgically treated and followed up for an average duration of（13.0±10.6）months. There was no statistical difference between postoperative and preoperative average cardiothoracic ratio （0.54±0.06 vs. 0.57±0.09，t=1.581，P＞0.05），morphologic right ventricle ejection fraction （52.8%±9.0% vs. 54.9%±9.5%, t =0.712，P＞0.05），and end-diastolic dimension of . morphological right ventricle （54.3±7.5 mm vs. 56.9±9.2 mm，t =0.988，P＞0.05）. There was statistical difference between postoperative and preoperative average end-diastolic dimension of left atrium（42.1±8.9 mm vs. 53.4±11.1 mm，t =3.286，P＜0.05）and NYHA classification（Z = -2.640，P＜0.05）. Conclusion Intravalvular implantation of morphologic tricuspid prosthesis can protect the physiological structure of morphologic right ventricular and prevent furtherdamage to its function caused by morphologic tricuspid valve insufficiency. Postoperative dimension of morphologic left atrium and cardiac function are significantly improved. The early and mid-term outcomes are satisfactory．
Abstract： Objective To evaluate early clinical outcomes and short-term follow-up results of CL-V bileaflet prosthesis. Methods From April 2004 to May 2010， 38 patients with valvular heart diseases underwent mechanical heart valve replacement. Eighteen patients received CL-V bileaflet valve replacement （CL group） including 8 males and 10 females with their mean age of （47.4±6.2）years and mean body weight of （64.7±11.9） kg. Preoperatively，15 patients were in New York Heart Association （NYHA） classⅢ， and 2 patients were in NYHA classⅣ. Mitral valve replacement （MVR） was performed in 16 patients， mitral and aortic valve replacement（DVR） in 2 patients. A total of 20 CL-V bileaflet prostheses were implanted. Twenty patients received St. Jude bileaflet valve replacement （SJM group）including 9 males and 11 females with their mean age of （49.7±7.6） years and mean body weight of （66.1±11.1） kg. Preoperatively， 15 patients were in NYHA classⅢ， and 3 patients were in NYHA classⅣ. MVR was performed in 17 patients，aortic valve replacement （AVR） in 1 patient， and DVR in 2 patients. A total of 22 St. Jude bileaflet prostheses were implanted. Clinical outcomes， hear function， hemodynamics and blood compatibility were measured on the 7th postoperative day and 6 months during follow-up and compared between the two groups. Results There was no early mortality （＜30 d） or postoperative complication in either group. Follow-up rate was 100% and the mean follow-up duration was 19.8 （6-61）months. At 6 months after surgery， those patients who were preoperatively in NYHA classⅢ orⅣall improved to classⅠ orⅡ. In CL group， cardiothoracic ratio was 0.51±0.05， left atrium diameter （44.5±7.8） mm， left ventricular end diastolic diameter （LVEDD，46.6±4.1） mm， LVEF 65.3%±7.7%，and LVFS 35.0%±7.1%. In SJM group， cardiothoracic ratio was 0.51±0.06， left atrium diameter （45.8±9.6） mm， LVEDD （46.2±9.8） mm， LVEF 64.1%±9.0%，and LVFS 34.9%±4.7%， which were not statistically different from those parameters of CL group respectively （P＞0.05）. At 6 months after surgery， transthoracic echocardiography was used to compare hemodynamics of bileaflet prostheses with same size 27 mm in the two groups. Prosthetic transvalvular gradient was （5.1±0.9）mm Hg in CL group and （5.8±0.8） mm Hg in SJM group， and effective orifice area was （2.3±0.3）cm2 in CL group and（2.5±0.2）cm2 in SJM group，which were not statistically significant between the two groups （P＞0.05） respectively. In both groups， the level ofhemoglobin， lactate dehydrogenase and platelet at 6 months postoperatively were all within normal range and not statistically from those respective preoperative parameters（P＞0.05）. Hemolytic reaction and hemolytic anemia were not found. During early and short-term follow-up， there was no thromboembolic complications or anticoagulation-related severe bleeding events in the two groups with same anticoagulation intensity target （target INR value 1.5 to 2.5）. Conclusion Early clinical outcomes and short-term follow-up results of CL-V bileaflet prostheses are similar to those of St. Jude bileaflet prostheses. Postoperative patients have good clinical outcomes， hemodynamics and blood compatibility. Patients’ heart function significantly improve during short-term follow-up without valve-related complication. Mid-term and Long-term follow-up are further needed to demonstrate its good performance.
Abstract： Objective To summarize our operative experiences of cardiac reoperation after mechanical valve prosthesis replacement and investigate the causes of reoperation and the perioperative techniques and operation methods. Methods From January 2001 to December 2008, we performed reoperation on 105 patients (59 males and 46 females, aged 50.2±10.6 years old) who had undergone mechanical valve prosthesis replacement. Among the patients, there were 31 cases of mitral valvular replacement (+ tricuspid valvular plasticity), 38 cases of aortic valvular replacement (+ tricuspid valvular plasticity), 11 cases of Bentall procedure, 7 cases of mitral and aortic bivalvular replacement (+tricuspid valvular plasticity), 8 cases of tricuspid valvular replacement, 6 cases of repairing of prosthetic leakage, and 4 others cases. The time interval between two operations was 3 months to 18 years (46.3 ±31.9 months). Before reoperation, the cardiac function (NYHA) of the patients was class Ⅱ in 27 patients, class Ⅲ in 53 patients, and class Ⅳ in 25 patients. Results There were 6 hospital deaths with a mortality of 5.71%(6/105). All others recovered to NYHA class ⅠⅡ. The causes of mortality included 1 case of multiple organ failure, 1 case of low cardiac output after operation, 1 case of aortic pseudoaneurysm rupture, 1 case of severe infection due to brain complication and 2 cases of prosthetic valve endocarditis (PVE). The causes for cardiac reoperation after mechanical valve prosthesis replacement were 67 cases of prosthetic leakage (63.80%), 16 cases of PVE (15.23%), 14 cases of prosthetic thrombosis (13.33%) and 8 cases of other valvular anomalies. Followup was done for 11 to 107 months, which showed two cases late deaths of cardiac arrest and cerebral hemorrhage. Conclusion Patients who have received mechanical valve prosthesis replacement may undergo cardiac reoperation due to paravalvular prosthetic leakage, paravalvular endocarditis, and prosthetic thrombosis. The keys to a successful cardiac reoperation include appropriate preoperative preparations, operational timing, and suitable choosing of cardiopulmonary bypass and operational skills.
Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients(20 male,11 female; age 31.9±11.7 years) with aortic coarctation and associated cardiac anomalies underwent onestage surgical repair through median sternotomy. The associated cardiac anomalies included: aortic valve insufficiency or stenosis(n=22); mitral valve insufficiency or stenosis (n=9); patent ductus arteriosus (n=5); ascending aortic aneurysm (n=4); ventricular septal defect (n=3); coronary artery disease (n=2). Extra-anatomic aortic bypass grafting was used to repair the coarctation. Routing of the grafts was: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal abdominal aorta (n=22). Concomitant cardiac procedures included: aortic valve replacement in 16; Bentall procedures in 6; mitral valve repair or replacement in 9; ascending aortic replacement or aortoplasty in 4; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an inhospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2±25.3 mm Hg preoperatively to 13.7±10.2 mm Hg postoperatively (Plt;0.05). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths，reoperations or graftrelated complications. Conclusion Extraanatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.
Objective To design a novel stentless porcine aortic bioprosthesis and test the feasibility and its function in vitro after the valve was implanted by a modified method. Methods Six stentless porcine aortic bioprosthesis were divided into two groups according to different implantation, single layer suture group: new improvement stentless porcine aortic bioprosthesis sutured with single layer was implanted; double layer suture group: stentless porcine aortic bioprosthesis developmented by our laboratory used double layer suture was implanted. Each group contained three scales: 23 mm ,25 mm and 27 mm. Analogue ex vivo aortic valve replacement was performed , the feasibility of the new implantation was detected. Effective orifice area, transvalvular pressure gradient and regurgitation ratio were recorded at the cardiac output of 2.0 L/min, 3.5 L/min, 5.0 L/min and 7.0 L/min under the guideline of International Organization for tandardization （ISO）5840. Results The average aortic valve implantation time used for single layer suture and tradition double layer suture were 50 min and 70 min respectively. The transvalvular pressure gradient in the single layer suture group were significantly lower than those in double layer suture group under the flow of 5.0 L/min in 23 mm valve and 27 mm valve （13.51±0.51 mm Hg vs. 14.44±0.99 mm Hg, 7.36±0.19 mm Hg vs. 7.53±0.28 mm Hg；P＜0.01）;and the effective orifice area in the single layer suture group were larger than those in double layer suture group in the same case(1.87±0.06 cm2 vs. 1.76±0.08 cm2, 2.26±0.07 cm2 vs. 2.16±0.05 cm2；P＜0.01). There was no statistically difference in other parameters between both groups. Conclusion The novel design of new improvement stentless porcine aortic bioprosthesis used single layer suture has good hemodynamic characteristics as the nature structure . The modified suture method decrease the implantation time.Nemerical data of the evaluation in vitro show that the difference between single layer suture group and double layer suture group in effective orifice area,transvalvular pressure gradient and regurgitation ratio haveno statistical significance. This experiment is the foundation of the animal and clinical experiment in the future.
Objective To analyze the causes of mechanical valve dysfunction and the reconstructive surgical procedure, and summarize the treatment experiences in perioperative period. Methods From October 1996 to October 2008, 12 276 patients underwent mechanical valve replacement in Fu Wai Hospital. Thirtytwo of them were reoperated because of mechanical valve dysfunction. There were 12 male and 20 female aged from 1661 years with an average age of 43.8 years. All the reoperations were performed under hypothermic cardiopulmonary bypass, including 16 mitral valve replacement, 8 aortic valve replacement, 3 aortic and mitral valve replacement, 3 tricuspid valve replacement, 2 disc rotation and 1 excision of an excessive knot. There were 13 emergency operation and 19 elective operation. Results The time of ventilator assistant respiration was 5.1-144.0 hours.The median time was 15 hours and tracheostomy was needed in 2 cases. Six patients died after reoperations, the mortality rate was 18.8%(6/32). Three died of low cardiac output syndrome, 2 died of multiple organ failure and 1 died of malignant arrhythmia. Three cases had complications. There were 1 infective endocarditis, 1 intractable hiccup and 1 incisional infection, respectively. They were all cured and discharged. Conclusion Prosthetic valve dysfunction is one of the serious complications after mechanical valve replacement. Early detection, early diagnosis and early reoperation are needed.
Objective To summarize the experiences of surgical treatment for periprosthetic leakage(PPL). Methods A total of 63 patients with PPL (mitral PPL in 34, aortic PPL in 29), age 41±12 years, underwent reoperation with prosthetic valve replacement from Dec. 1980 to Dec. 2005 in this department. Patient characteristics, operative profiles and follow-up data were described and analyzed in detail. Results The perioperative complications occurred in 11 patients (17.5%), five of whom died (the overall hospital mortality: 7.9%). Fifty-five patients were in close follow-up and three of them lost in that period, five patients died in late. Fifty patients long-term survivals were in New York Heart Association class Ⅰ-Ⅱ and follow-up evaluation by echocardiography showed no evidence of recurrence or residual PPL and PPL-related complications. Conclusion More attention should be paid to the study on etiology, pathophysiology, diagnostic methods, and clinical classification of PPL. For patients with PPL, reoperation with prosthetic valve replacement is considerably effective and can obtain an acceptable longterm results.
Objective To introduce a new type of bileaflet mechanical prosthetic heart valve （GK bileaflet valve）and evaluate clinically the early hemodynamic effect and short term follow-up after its replacement. Methods Sixty-one patients with heart valve diseases were operated upon. The mitral valve replacement was performed in 34 patients, aortic valve replacement in 16 patients and double valve replacement in 11 patients. A total of 72 GK bileaflet mechanical valves were implanted, 45 in mitral position, and 27 in aortic position. Blood consistency and hemodynamics were monitored. Follow-up was carried out routinely to check whether there were some valve-related complications. Results There was no early mortality （〈30 d）. Only one patient died of trauma 2 months after the operation. Follow-up was 100% and extended 1 to 2. 5 years. Without valve-related complications all patients had lived for more than 1 to 2.5 years. In 98% （60/61） of survivors heart functional performance had improved to New York Heart Association class Ⅰ or Ⅱ . Conclusion Early clinical results and short term follow up demonstrate that GK bileaflet prosthetic heart valve exhibits excellent hemodynamic properties, satisfied blood consistency and a low incidence of valve-related complications. Midterm and long-term results should be observed further.