Objective To explore and conclude the influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration.Methods To review the in-patient data and followup outcomes of 261 patients after mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration from Jan 1993 to Jan 2008 in Changhai Hospital of Second Military Medical University.Results There were 7 perioperative deaths and 254 survivors who obtained satisfactory perioperative outcomes.During the follow-up,24 patients were lost and 230 patients were followed up from 36 months to 174 months (77.3 ±30.3) months and follow-up rate was 90.6％.Multivariate Cox regression shows age ≥ 60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting were the independent risk factors for long-term death after operations and left ventricular ejection fraction ＜ 0.50,New York Heart Association functional classification Ⅲ-Ⅳ,anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and prosthetic ring or band annulopasty was a protective factor.Conclusion The age ≥60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting,New York Heart Association functional classification Ⅲ - Ⅳ,anterior leaflet prolapse,and prosthetic ring or band annulopasty were closely related with long-term adverse events after operations.

Objective To explore whether clinically mild functional tricuspid regurgitation should be addressed at the time of mitral valve repair(MVP) for moderate or severe mitral regurgitation due to myxomatous degeneration.Methods We retrospectively analyzed the outcomes of 135 patients with moderate or severe mitral regurgitation due to myxomatous degeneration with mild functional tricuspid regurgitation.All patients were treated between January 1993 and March 2008 in the Department of Cardiothoracic Surgery of Changhai Hospital,the Second Military Medical University.We divided the patients into a MVP group(n=76) and a MVP+tricuspid valvuloplasty(TVP) group(n=59) according to whether they underwent combined TVP,and observed the perioperative mortality rate,degree of tricuspid regurgitation,and compared survival rate,and freedom from long-term moderate or severe tricuspid regurgitation after operation.Cox regression was used to analyze the risk factors for long-term moderate or severe tricuspid regurgitation after operations.Results(1) There were no deaths during the perioperative period,and postoperative transthoracic echocardiography of all patients indicated that tricuspid regurgitation was mild or less.(2) Survival rate at 5 years,10 years after operations in MVP group was 98.4%,95.0%,respectively,and survival rate at 5 years,10 years after operations in MVP+TVP group was 100.0%,93.7%,respectively,and there was no significant difference in the survival rate after operations between the two groups(P=0.311),but there was a significant difference in the freedom from long-term moderate or severe tricuspid regurgitation after operations between the two groups(P=0.040).Multivariate Cox regression showed that preoperative pulmonary artery pressure >30 mm Hg(95%CI 1.127 to 137.487,P=0.040)and atrial fibrillation(95%CI 1.177 to 23.378,P=0.030) were independent risk factors for long-term moderate or severe tricuspid regurgitation after operations.Conclusion TVP is necessary for most patients undergoing MVP for moderate or severe mitral regurgitation due to myxomatous degeneration who have coexistent mild functional tricuspid regurgitation,especially those patients with preoperative pulmonary artery pressure >30 mm Hg or atrial fibrillation.

目的:观察严重二尖瓣狭窄合并左室功能减退患者行二尖瓣置换的手术死亡率和远期效果。方法:回顾性分析自1995年4月至2006年10月间55例严重二尖瓣狭窄合并左室收缩功能减退行二尖瓣置换术患者的临床资料和长期随访结果,其中男性23例,女性32例,平均年龄(44.25±9.38)岁。均为风湿性心脏病,二尖瓣瓣口面积平均为(0.76±0.15)cm2,左室射血分数(EF)平均为(42.65±5.40)%。术前心功能Ⅳ级12例,Ⅲ级40例。术前无合并冠心病患者。结果:本组术后30d内死亡4例,手术死亡率为7.27%。死亡原因:左室破裂2例,严重呼吸功能衰竭1例,猝死1例。生存的51例患者早期均得到随访,随访至2007年8月,失访3例,随访率94.55%,随访时间平均为(5.07±3.17)年。5年、11年的生存率分别为(96.00±3.00)%、(74.00±14.00)%;没有出现栓塞相关并发症;出现1例脑出血;没有因细菌性心内膜炎或瓣膜功能障碍等再次手术的病例。44例存活患者的NYHA心功能分级Ⅰ级7例,Ⅱ级35例,Ⅲ级2例。心脏超声显示EF41%~73%,平均(52.58±7.19)%(P<0.05)。结论:对严重二尖瓣狭窄合并左室收缩功能减退的患者如能加强围术期的处理,也有良好的手术及远期效果。

目的:评价应用国产C-L短柱倾斜碟瓣心脏瓣膜置换术的近期与远期疗效,分析影响手术疗效的因素。方法:回顾性分析自1991年10月至2003年12月,607例行国产C-L短柱倾斜碟瓣置换术患者的临床资料和长期随访结果,其中二尖瓣置换259例,主动脉瓣置换91例,二尖瓣、主动脉瓣双瓣置换257例。年龄平均(40.00±12.12)岁。术前纽约心功能分级:Ⅳ级88例,Ⅲ级366例,Ⅱ级255例,Ⅰ级4例;术前合并脑梗17例,房颤309例,左房血栓25例,严重肺动脉高压35例,冠心病4例,高血压病1例,糖尿病1例。结果:本组早期死亡40例,手术死亡率为6.59%。1996年后手术死亡率降至3.64%。死亡原因主要为心功能衰竭和多脏器功能衰竭。术后早期未出现与瓣膜相关的并发症。出院的567例患者随访率为94.89%,随访时平均(7.32±3.25)年。晚期死亡患者58例,主要死亡原因为心功能衰竭,在已知的死亡原因中没有由于瓣膜结构损坏造成患者死亡。出院患者5年、10年和12年的生存率分别为(96.66±1.42)%、(85.29±1.94)%和(76.56±5.22)%;无血栓栓塞率分别为(97.86±0.71)%、(91.50±1.97)%和(91.50±1.97)%;无出血率分别为(95.61±1.02)%、(91.97±1.26)%和(88.90±2.73)%。480例存活患者中,NYHA心功能恢复至Ⅰ级334例(69.58%),Ⅱ级120例(25.00%),Ⅲ级21例(4.38%),Ⅳ级5例(1.04%)。结论:通过12年的长期随访显示,国产C-L短柱侧倾碟瓣是人造机械心脏瓣膜可靠的选择。

OBJECTIVE:To investigate the mRNA and protein expression of mineralocorticoid receptor (MR) in patients with atrial fibrillation. METHODS:Twenty-five patients with rheumatic heart valve disease, 12 in sinus rhythm and 13 in chronic atrial fibrillation (>or= 6 months), underwent transthoracic echocardiography and right and left atrial lateral wall tissue samples were obtained from these patients during mitral/aortic valve replacement operation. Realtime quantitative PCR and Western blot were used to determine the mRNA and protein expression of MR in atria specimens. The distribution of MR in human atria was analyzed by specific immunohistochemical staining. RESULTS:The left atrial diameters increased markedly in atrial fibrillation group compared with that in sinus rhythm group (P<0.01). And the results showed that the level of mRNA and protein of MR were increased significantly in atrial fibrillation group compared with those in sinus rhythm group (P<0.01 or 0.05), whereas the expression of mRNA and protein of MR were found to be no difference between left atria and right atria both in fibrillation and sinus groups (all P>0.05). The special immunohistochemical staining demonstrated that MR was abundant in the human atrial myocardium and MRs were located mainly in the cytoplasm of atrial cells, which were more evident in atrial fibrillation group than those in sinus rhythm group. CONCLUSION:These findings suggested that MRs were upregulated in atrial fibrillation and aldosterone antagonists may be effective in treating atrial fibrillation.

Objective To investigate the surgical procedure and efficacy for aortic valve endocarditis with paravalvular abscess. MethodsFrom June 1991 to June 2006,21 cases of aortic valve endocarditis with paravalvular abscess were retrospectively studied.Among them,14 were male and 7 were female,and the mean age was 39.2 years(14 to 60 years).The lesion of 15 cases were on native aortic valve and 6 were on prosthetic aortic valve.The aortic wall and peravalvular defect was repaired by patch in 9 cases,including 3 fistulous tracts between the aorta and main pulmonary artery.Bentall procedure was performed in one case because the aortic wall and paravalvular were infected so seriously that it could not be repaired by patch.The valvular annulus was rebuilt by autologous or bovine pericardium in another 3 cases.No patch repair was done in 8 cases.Aortic valve replacement was performed in 20 and Bentall procedure was performed in 1.All 21 artificial heart valves were mechanical. Results Two patients(9.5%) with prosthetic valve endocarditis died of multiple organs failure earlier postoperatively.During 3 months to 15 years follow-up(mean 5.7 years),19 patients survived without later mortality,recurrence of endocarditis and paravalvular leakage.Conclusion The surgical principle for aortic valve endocarditis with paravalvular abscess is to clear infectious sites thoroughly,handle aortic valve properly so as to improve heart function and prevent re-infection with effective antibiotics.

Objective:To investigate the correlation between atrial tissue aldosterone level and atrial extracellular matrix remodeling in patients with atrial fibrillation and to evaluate the effects of aldosterone on the progress of atrial structural remodeling. Methods: Twenty-five patients with rheumatic heart valve disease (12 with sinus rhythm, 13 with chronic atrial fibrillation for ≥6 months) were included in the present study. The right and left atrial lateral wall tissue samples(12 right and 7 left atrial samples in patients with sinus rhythm; 13 right and 8 left atrial samples in patients with atrial fibrillation)were obtained during mitral/aortic valve replacement operation. Radioimmunoassay was used to determine aldosterone level in local atria. Type Ⅰor Ⅲ collagen volume fraction (CVF-Ⅰor CVF-Ⅲ) and total collagen volume fraction (CVF) were analyzed by immunohistochemistry and VG staining, respectively. Results: The left atrial diameters increased markedly in the atrial fibrillation group as compared to those in the sinus rhythm group(P0.01). Aldosterone level, CVF-Ⅰ, CVF-Ⅰ/CVF-Ⅲ ratio, and total CVF in atrial fibrillation group were also increased significantly than those of sinus rhythm group(P0.01), whereas CVF-Ⅲ remained compatible in the 2 groups. Aldosterone level, CVF-Ⅰ, CVF-Ⅰ/CVF-Ⅲ ratio, and total CVF were similar between the left atria and right atria in both groups. It was found that CVF-Ⅰwas positively correlated with the left atrial dimension (r=0.856, P0.001), CVF was positively correlated with left atrial dimension(r=0.845, P0.001), and CVF-Ⅰ/CVF-Ⅲ ratio was positively correlated with atrial fibrillation duration(r=0.766,P0.01). Aldosterone level in local atria was also positively correlated with left atrial dimension (r=0.814,P0.001) and CVF (r=0.885,P0.001). Conclusion: Local atria aldosterone level may promote the process of atrial structural remodeling in patients with atrial fibrillation and may also participate in the development and persistence of atrial fibrillation.

OBJECTIVE:To investigate the mRNA and protein expression of mineralocorticoid receptor (MR) and 11-beta-hydroxysteroid dehydrogenase type 2 (11betaHSD2), which plays a crucial role in the human heart to confer specificity on MR, in patients with chronic atrial fibrillation. METHODS:Twenty-five patients of rheumatic heart valve disease, 12 with sinus rhythm, and 13 with chronic atrial fibrillation for 6 months or over, underwent transthoracic echocardiography and mitral/aortic valve replacement operation during which right atrial lateral wall tissue samples were obtained and left atrial lateral wall tissue samples were obtained from 14 of them in addition. Realtime quantitative PCR was used to determine the mRNA expression of MR and 11betaHSD2 and Western blotting was employed to detect the protein expression of MR and 11betaHSD2 in the atrial myocardium. RESULTS:The left atrial diameters increased markedly in the atrial fibrillation group as compared to the sinus rhythm group (P < 0.01). The mRNA expression of MR in the right atrium of the patients with atrial fibrillation was 5.37 +/- 1.15, significantly higher than that of the patients with sinus rhythm (2.67 +/- 1.09, P < 0.01), the mRNA expression of MR in the left atrium of the patients with atrial fibrillation was 5.19 +/- 1.14, significantly higher than that of the patients with sinus rhythm (270 +/- 0.82, P < 0.01). The mRNA expression of 11betaHSD2 in the right atrium of the patients with atrial fibrillation was 0.86 +/- 0.14, significantly higher than that of the patients with sinus rhythm (0.33 +/- 0.12, P < 0.01), and the mRNA expression of 11betaHSD2 in the left atrium of the patients with atrial fibrillation was 0.95 +/- 0.15, significantly higher than that of the patients with sinus rhythm (0.37 +/- 0.10, P < 0.01). The protein expression of MR in the right atrial tissue of the patients with atrial fibrillation was 1.65 +/- 0.72, significantly higher than that of the patients with sinus rhythm (0.86 +/- 0.33, P < 0.01); and the protein expression of MR in the left atrial tissue of the patients with atrial fibrillation was 1.72 +/- 0.62, significantly higher than that of the patients with sinus rhythm (0.97 +/- 0.37a, P < 0.05). The protein expression of 11betaHSD2 in the right atrial tissue of the patients with atrial fibrillation was 1.18 +/- 0.64, significantly higher than that of the patients with sinus rhythm (0.71 +/- 0.21, P < 0.05); and the protein expression of 11betaHSD2 in the left atrial tissue of the patients with atrial fibrillation was 1.36 +/- 0.58, significantly higher than that of the patients with sinus rhythm (0.85 +/- 0.15, P < 0.05). The mRNA expression and protein expression of MR and 11betaHSD2 were not significantly different between the left atria and right atria both in the fibrillation and sinus groups (all P > 0.05). CONCLUSION:The mRNA expression and protein expression of MR and 11betaHSD2 are upregulated in atrial fibrillation and aldosterone antagonists may be effective to arrest the development of sustained atrial fibrillation.

Objective To evaluate the effect of staged repair for tetralogy of Fallot (TOF) associated with pulmonary artery hy- poplasty.Methods From June 1996 to June 2006,37 patients with TOF were operated on.There were 26 males and 11 females. Their age was 5 months to 17 years(mean 3.6 years) and weight was 4.6～38.0 kg.All patients were diagnosed as TOF with pulmo- nary artery hypoplasty by cardiac catheterization.The mean pre-operative arterial saturation of the patients was (68.2±6.5) %,Mc- Coon ratio was 0.95±0.26 (0.81～1.17) and Nakata index was 82.7±21.6(71.6～97.5) mm~3/m~2.At the time of the first surgi- cal procedure,17 patients underwent central aortopulmonary shunt,13 patients received modified Blalock-Taussig shunt in the left side and 7 patients had modified Blalock-Taussig shunt in the right side.Results There were no easly operative deaths and no late deaths after the first stage repair.Pleural effusion after shunt occurred in 5 patients.The mean arterial saturation was significantly increased to (91.3±10.4) %,P0.01.Hemoglobin decreased from (15.6±2.7) % in pre-operation to (12.5±2.2) % in post-operation (P0.05).The total correction of TOF was performed in 37 patients from 6 to 31 months (mean 10.7 months) after shunt,the mean McGoon ratio increased to 1.82±0.43 (P0.01)and the mean Nakata index increased to (176.8±46.8)mm~3/m~2 (P 0.01).There was one early death (2.7 %) and no late deaths after the total correction.Conclusion Staged repair promotes devel- opment of the pulmonary arteries,improves cyanosis of patients with TOF and pulmonary artery hypoplasty,better results may be ex- pected for the total correction.

Background: Triple valve surgery (TVS) is stilt of choice for advanced rheumatic heart disease (RHD), which has been associated with reported poor early and late outcomes. We describe the short-and long-term results after TVS in last two decades in Mainland China.Methods: From January 1985 to January 2005, a total of 871 patients (217 men, 654 women), with mean age of 42 +/- 11 years, underwent primary TVS for isolated advanced RHD. All patients received replacement procedures in mitral and aortic position (845 mechanical, 26 bioprosthetic), and 840 patients received repair procedures and the other 31 received replacement procedures in tricuspid position (9 mechanical, 22 bioprosthetic). Preoperative, perioperative, and postoperative data were retrospectively analyzed and risk factors affecting early and late survival were evaluated.Results: The 30-day hospital mortality was 8% (n = 71). Presence of ascites, New York Heart Association (NYHA) class IV and tower left ventricular ejection fraction (I-VEF) were identified as independent risk factors for hospital mortality. Overall long-term survival rate was 71% +/- 3% at 5 years, and 59% +/- 5% at 10 years. The cardiac survival rate was 75% +/- 3% at 5 years and 63% +/- 4% at 10 years. The event-free survival rate at 5 years and 10 years was 61% +/- 6% and 41% +/- 13%, respectively. Multivariate analysis revealed advanced age, NYHA class Wand tower LVEF were associated with increased late mortality. The freedom from thromboembolism and anticoagulation-related hemorrhage at 10 years was 90% +/- 4% and 81% +/- 5%, respectively. Of the 508 patients stilt alive, 376 (74%) were in NYHA class I and II.Conclusions: Primary TVS for advanced RHD appears to offer satisfactory short- and long-term results with excellent symptomatic improvement. Cardiac-related late mortality following TVS may be improved by early surgical treatment before NYHA class IV or deterioration of I-VEF occurs. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved..

Objective To evaluate the acute and chronic effects of surgical intervention with right- sided maze procedure for atrial fibrillation(AF)in patients with congenital heart disease.Methods Between Apr.1998 and May.2003,there were 26 patients with AF complicating congenital heart diseases(21 with atrial septal defect and 5 with Ebstein's anomaly)enrolled in this study.They were divided into maze group(n=15)or control group(n=11),according to whether having undergone right-sided maze procedure during open heart corrective surgery.Documented AF included chronic AF in 19 and paroxysmal AF in 7,with the duration ranged from 1 year to 8 years.Associated mitral valve disease was excluded.Evaluation was performed before surgery,at discharge and 1,6,12 months after surgery.Atrial filling fraction (ventricular filling related to atrial contraction to total ventricular filling ratio) marked by transtricuspid flow A wave or transmitral flow A wave detected by Doppler echocardiography was used as an index of atrial contraction.Results In maze group,12 patients recovered to sinus rhythm soon after aortic unclamping and 2 patients developed transient junctional rhythm.One patient was still with paroxysmal atrial fibrillation after the surgery,but converted to sinus rhythm eventually by taking oral amiodarone for 2 weeks.In control group,2 patients recovered to sinus rhythm after operation including 1 with oral amiodarone.Three patients developed junctional rhythm with 1 converted to sinus rhythm and 2 to AF.However,only 1 patient was with sinus rhythm and 9 were still with AF at discharge.Follow-up was ac- complished in all the patients and ranged from 1 year to 5 years(mean 27.5 months).At the 1-year follow-up evalouation,most patients(93.3%)in maze group were with sinus rhythm.Both right and left atrial filling fraction were significantly improved compared to that before operation (55.5%±80% vs 14.2%±3.4% at the right and 53.1%±6.4% vs 19.9%±4.4% at the left,P0.01)with 73.3% of patients in NYHA functional class I.While in control group,81.8% of patients were with AF which needed to take oral anticoagulation therapy,and 14.2% were with junctional rhythm.Neither the right nor the left atial filling fraction was improved after operation.Only 45.4% of patients were in NYHA functional class I.Conclusions Concomitant right-sided maze procedure,which does not increase the acute mortality,is effective in eliminating AF associated with congenital heart diseases and improving atrial transporting function with a satisfactory acute and chronic clinical outcome.

Objective To investigate aldosterone in local atria, the mRNA expression of aldosterone synthase CYP11B2 and atrial structural remodeling in patients with chronic atrial fibrillation, and to find the association of these factors. Methods Twenty-five patients with rheumatic heart valve disease, 12 patients in sinus rhythm and 13 in chronic atrial fibrillation(≥6 months) ,underwent transthoracic echocardiography. Right and left atrial lateral wall tissue samples were obtained simultaneously from these patients during mitral/aortic valve replacement operation. Radioimmunoassay was used to determine aldosterone in local atria and collagen volume fraction (CVF) was analyzed by VG staining. The mRNA expression of aldosterone synthase CYP11B2 in atrial myocardium was determined by using realtime quantitative PCR. Results The left atrial diameters increased markedly in atrial fibrillation group as compared to sinus rhythm group(P 0. 01). Compared with that of sinus rhythm groups, the aldosterone in local atria was increased significantly in atrial fibrillation group(P 0. 001). VG staining revealed that CVF increased significantly in atrial fibrillation groups compared with that in sinus rhythm group( P 0. 001). And the level of mRNA of CYP11B2 was increased greatly in atrial fibrillation groups compared with that in sinus rhythm(P 0. 001). But the aldosterone, CVF and the mRNA expression of CYP11B2 were found to be no difference between left atria and right atria both in fibrillation and sinus groups (all P 0. 05). CVF significantly correlated with left atrial dimension ( r = 0. 845 ,P 0. 001). And aldoste- rone was found to be significantly positive correlated with left atrial dimension (r=0. 814, P 0. 001) and CVF ( r = 0. 885 , P 0. 001). There was also a positive correlation between the mRNA level of CYP11B2 and CVF (R =0. 757, P 0. 001). Conclusions Atrial structural remodeling during atrial fibrillation is manifested by increased aldosterone level in local atria along with upregulation of the mRNA of CYP11B2. These findings suggest that aldosterone antagonists may be effective in arresting atrial structural remodeling and the development of sustained atrial fibrillation.

目的 探讨单纯二尖瓣置换术的近远期疗效.方法复习1978年12月至2003年12月期间施行单纯二尖瓣置换手术3416例的病例和随访资料,统计分析术后远、近期病死率、死亡原因、并发症以及影响疗效的高危因素.结果风湿性二尖瓣病变占91.80%,合并功能性三尖瓣关闭不全或器质性病变达50.32%,合并慢性疾病者为8.92%.手术死亡率为3.25%,主要死因是心力衰竭;总随访时间24735.83病人·年,20年累计生存率为(86.36±0.74)%;晚期病死率为0.84%病人·年,心力衰竭仍是主要死因.血栓栓塞为0.18%病人·年,与抗凝有关出血为0.68%病人·年;手术前心功能IV级、肾功能衰竭、严重感染和多脏器功能衰竭是显著影响手术死亡的高危因素.结论合理选择手术时机、重视三尖瓣关闭不全和心律失常的处理、积极防治风湿病复发有助于改善二尖瓣病变的手术预后。

目的评价应用自体心包瓣膜置换肺动脉瓣治疗器质性肺动脉瓣病变的临床效果.方法心脏病合并器质性肺动脉瓣病变5例,经0.625%戊二醛缓冲液浸泡处理过的心包片,用相应的特制模具进行裁制,重建肺动脉瓣和瓣膜交界.结果全组无死亡,术后1个月内复查超声心动图,除1例因交界重建不良、肺动脉瓣存在每搏6.5ml的中量反流外,其余患者每搏反流量均小于1ml,瓣膜活动良好.随访6～48个月,术后肺动脉瓣中量反流患者的肺动脉瓣每搏反流量减少至4.2ml,其余患者每搏反流量均无明显变化,心功能恢复良好.结论应用自体心包瓣膜置换肺动脉瓣,手术的近期效果满意,瓣膜重建的关键在于精确测定肺动脉瓣环并选择相应的成瓣模具、以及自体心包瓣叶交界的重建.

目的报告先心病室间隔缺损合并主动脉瓣关闭不全的外科治疗和经验.方法全组62例室间隔缺损合并主动脉瓣关闭不全患者,男43例,女19例,年龄5-31岁,平均15.2±5.5岁.室缺大小为16-24mm,动脉干下型14例,膜周型48例.62例均有中重度主动脉瓣关闭不全.术前肺动脉压为47-109mmHg.心功能Ⅱ级51例,Ⅲ级9例,Ⅳ级2例.合并病变:感染性心内膜炎6例,动脉导管未闭4例,房间隔缺损7例,中重度二尖瓣关闭不全5例,中重度三尖瓣关闭不全11例.室缺均采取补片修补.主动脉瓣关闭不全的处理:23例行主动脉瓣置换术,其中3例拓宽主动脉瓣环(Manougnian法)后行主动脉瓣置换,36例行主动脉瓣悬吊折叠成形术,3例行自体肺动脉瓣叶移植置换主动脉瓣叶.同期处理合并的畸形.结果本组病例全部存活无死亡.术后随访6个月-16年(平均6.7±3.4年),无晚期死亡,1例主动脉瓣悬吊折叠成形者有轻度主动脉瓣关闭不全.结论先心病室间隔缺损合并主动脉瓣关闭不全患者应尽早手术治疗,主动脉瓣关闭不全可采取瓣膜成形人造心脏瓣膜置换等技术处理,治疗效果理想.

1 临床资料患者男性,30岁,因活动后心慌、胸闷伴剧烈咯血于2002年7月入院.术前心脏超声心动图发现左房壁团块状占位,基底部宽,活动度小,部分肺静脉回流受阻,二尖瓣中度反流,拟诊为"左房黏液瘤".在全麻中度低温体外循环下手术,经房间隔探查,发现左房内充满灰白色鱼肉样肿瘤,与左房壁紧密粘连,并向右肺静脉及左上肺静脉内浸润性生长,侵及二尖瓣后瓣,瓣膜活动受限.

OBJECTIVE:To elucidate the early and long-term results of surgical treatment for complex infective endocarditis with prosthetic valve replacement.METHODS:Fifty-seven patients of complex native valve endocarditis, including 25 cases of aortic valve, 16 of mitral valve and 16 of double valves, who underwent operative interventions with prosthetic valve replacement between December 1988 and June 2002, were analyzed retrospectively. Intraoperative findings demonstrated aortic annular abscesses (n = 19), root abscesses (n = 4), mitral posterior annular abscesses (n = 11), myocardial abscesses (n = 6), massive leaflet destruction (n = 32) and valvular vegetations (n = 55). Complex reconstruction of the aortic and mitral annulus was required in 35 patients. Associated procedures included Bentall's procedure (n = 4), aortic valve replacement (n = 21), mitral valve replacement (n = 16) and double valve replacements (n = 16).RESULTS:The operative mortality was 11%. Complications included low cardiac output syndrome, recurrence of endocarditis, multiple organ failure, ventricular arrhythmia, bleeding, mediastinal infection, respiratory insufficiency and heart block. Follow-up was 100% complete at a mean of 5.93 years. There were five late deaths (3 prosthetic valve endocarditis, 2 valve-related). The NYHA functional status recovered to Class I in 17 patients, Class II in 27 and Class III in 2 at 1 year follow-up. Kaplan-Meier analysis showed the 5-year actuarial freedom from reoperation was (84 +/- 3)%, and actuarial survivorship at 5 years was (61 +/- 9)%.CONCLUSIONS:Urgent or even emergency operation is advocated for complex infective endocarditis. Proper intraoperative reconstruction of the aortic and mitral annulus and optimized perioperative management, especially the strategy for prevention of recurrent endocarditis, are of great importance in achieving satisfied early and long-term clinical outcomes.

Objective To study effects of mitral valve replacement(MVR) on the old with mitral valve diseases(MVD). Methods The documents of 265 cases undergoing MVR were reviewed, who aged 60 years old or over between June 1991 and June 2003. Demographices, clinical preoperative conditions, indications to surgery, early postoperative course and long-term outcome were collected via hospital documents and outpatient follow-up. Many risk factors were analysed. Results Follow-up rate amounted to 93.7%(236/252). The mortality was 4.9% (13/265) within 30 days. Heart failure and renal failure were the main cause of death. Compared with younger patients(60 years old), long-term survival rate was lower in the old, 5-year 87.52% vs 96.84%, 10-year 81.23% vs 94.87%. There were 15 late deaths(0.17% case/M), most of whom died of heart failure, cancers and lung infections. Risk factors for MVR in the old included New York Heart Association class Ⅳ, diabetes, and lung incompetence. Conclusions The patients with MVD over 60 years old tended to present high postoperatively mortality and morbidity.

者女,50岁.因反复咳嗽、发热10年,加重伴右侧胸痛、咳咖啡样脓痰、呼吸困难1个月入院.查体:右侧卧位,右侧颈静脉怒张,气管左偏,呼吸急促,右侧胸腔叩诊呈实音,右侧呼吸音消失;腹胀,肝大,移动性浊音阳性;双下肢及低位皮下水肿明显.血常规:白细胞8.7×109/L,中性粒细胞0.90;囊液培养为铜绿假单孢菌感染;胸部X线片示右肺囊性占位性病变(图1); CT:右侧胸腔囊肿,18 cm×15 cm×15 cm,CT值12～15(图2).

目的:总结86例心脏粘液瘤外科治疗经验.方法:回顾性分析86例心脏粘液瘤病例手术资料,左房粘液瘤58例,右房粘液瘤28例,均在体外循环下行粘液瘤摘除.结果:86例均痊愈出院,同期行三尖瓣成形14例,三尖瓣与二尖瓣成形4例,二尖瓣置换4例.结论:术中应注意麻醉诱导与插管方法,选择恰当的手术径路,防止瘤体破碎、脱落造成栓塞,切除粘液瘤要彻底.