Postoperative atrial fibrillation (POAF) is commonly seen in patients undergoing coronary artery bypass grafting (CABG), increasing the risk of morbidity, mortality and hospital expenses. This study is aimed to evaluate the effect of partial cardiac denervation, which is achieved by cutting off the ligament of Marshall and resecting the fat pad along the Waterston groove, on the prevention of POAF after CABG. Patients planned for CABG at our center will be screened for eligibility for this study. A total of 430 patients will be randomized into intervention (partial cardiac denervation) group and control group. Intraoperative high-frequency electrical stimulation and further histologic analysis will be performed among certain number of patients to confirm the existence of ganglia. All of the patients will be continuously monitored for the incidence of POAF through electrophysiologic device until the 6th day postoperatively, and required to complete a 30-day follow-up (twelve lead electrocardiogram and echocardiogram assesment) after discharge. The primary endpoint is the incidence of POAF, while the secondary endpoints are the cost-effectiveness and safety outcomes. In conclusion, this trial will evaluate whether partial cardiac denervation through cutting off the ligament of Marshall and resecting the fat pad along the Waterston groove can reduce the incidence of POAF after CABG. If this procedure is revealed to be effective and safe, it may provide a potential therapeutic approach to prevent POAF in this group of patients.

OBJECTIVE:Previous studies have demonstrated that preoperative oral carbohydrates (CHO) can alleviate postoperative insulin resistance (IR) and enhance recovery in non-diabetic patients undergoing cardiac surgery. However, the potential benefits in diabetic patients remain unclear. This study aimed to investigate the effects of preoperative CHO on IR and postoperative recovery in diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB). DESIGN:A prospective, single-center, single-blind, randomized controlled trial. SETTING:The study was conducted in the Adult Cardiac Surgery Ward 6 of a large-volume cardiovascular center. PARTICIPANTS:A total of 62 consecutive diabetic patients scheduled for isolated OPCAB were prospectively enrolled between July 8, 2022, and April 28, 2023. Participants were randomized in a 1:1 ratio to the CHO group or the control (CTRL) group using computer-generated random numbers. INTERVENTIONS:Patients in the CHO group received 335 mL of a carbohydrate drink containing 50 g of carbohydrates 8 to 12 hours before surgery, while those in the CTRL group followed routine fasting protocols. MEASUREMENTS AND MAIN RESULTS:The primary endpoint was postoperative IR, assessed by the homeostasis model assessment. Secondary endpoints included postoperative inflammatory markers and stress responses (e.g., serum cortisol levels), while exploratory endpoints focused on in-hospital clinical outcomes. Baseline characteristics were comparable between groups. CHO administration significantly reduced postoperative inflammatory markers but did not significantly improve IR. Stress response was attenuated in the CHO group, though the difference was not statistically significant. Postoperative drainage was higher in the CHO group, but no differences were observed in other clinical outcomes. CONCLUSION:Preoperative CHO may attenuate inflammatory and stress responses without increasing perioperative risk in diabetic patients undergoing OPCAB, although its effect IR remains uncertain.

OBJECTIVE:We aimed to examine biventricular remodeling and function after Ebstein anomaly (EbA) surgical correction using echocardiographic techniques, particularly, the relations between the biventricular changes and the EbA types. METHODS:From April 2015 to August 2022, 110 patients with EbA were included in this retrospective study based on the Carpentier classification. Echocardiography assessments during the preoperative, early, and mid-term postoperative periods were performed. RESULTS:The 54 patients with types A and B EbA were included in group 1, whereas the 56 patients with types C and D were in group 2. Seventy-eight patients underwent surgical correction of EbA. The median age at operation was 8.8 years. During the mid-term follow-up, only 9.1% of the patients had moderate or severe tricuspid regurgitation. Right ventricular (RV) systolic function worsened in group 2 at discharge (fractional area change: 27.6 ± 11.2 vs. 35.4 ± 11.5 [baseline], P < 0.05; global longitudinal strain: -10.8 ± 4.4 vs. -17.9 ± 4.7 [baseline], P = 0.0001). RV function slowly recovered at a mean of 12 months of follow-up. Regarding left ventricular (LV) and RV systolic function, no statistical difference was found between before and after surgery in group 1. CONCLUSION:A high success rate of surgical correction of EbA, with an encouraging durability of the valve, was noted. Biventricular systolic function was maintained fairly in most patients with types A and B postoperatively. A late increase in RV systolic function after an initial reduction and unchanged LV systolic function were observed in the patients with types C and D postoperatively.

目的:在有慢性心力衰竭(心衰)症状的冠心病伴左心室室壁瘤患者中,探讨在冠状动脉旁路移植术(CABG)的基础上行左心室成形术(SVR)能否进一步改善患者的长期预后.方法:于2010年5月至2013年5月连续纳入130例慢性心衰症状明显的冠心病伴左心室室壁瘤患者,分为CABG+SVR组(n=65)与单纯CABG(I-CABG)组(n=65).所有患者于术前1个月内行延迟钆增强心脏磁共振成像(LGE-CMR)检查,用国际通用的17节段分析法评估患者的瘢痕心肌及心功能.对所有患者通过门诊或电话进行随访,了解其症状和心功能改善情况以及心衰再入院和其他心血管事件的发生情况.采用Cox模型分析影响患者预后的危险因素,采用Kaplan-Meier生存分析比较两组患者的长期生存率.结果:两组患者的基线临床特征、左心室功能和心肌LGE情况均相似.与I-CABG组相比,CABG+SVR组体外循环时间[(116.0±36.2)min vs.(100.3±23.9)min,P=0.004]和机械通气时间[23(17,37)h vs.20(15,24)h,P=0.005]均明显延长.平均随访(127.3±12.6)个月期间,两组患者的症状和心功能均明显改善,CABG+SVR组改善更明显.CABG+SVR组心衰再入院的发生率明显低于I-CABG组(3.1％vs.20.6％,P=0.002),但两组的死亡率差异无统计学意义(1.6％vs.4.8％,P=0.600).Cox多因素分析显示,手术策略是心衰再入院的独立危险因素(CABG+SVR vs.I-CABG:HR=0.072,95％CI:0.015～0.340,P=0.001),CABG+SVR组无心衰再入院及其他心血管事件的生存率明显高于I-CABG组(89.1％vs.66.7％,P=0.003).结论:在慢性心衰症状明显的冠心病伴左心室室壁瘤患者中,与I-CABG相比,CABG+SVR能够进一步改善患者的心功能及临床症状,显著降低心衰再入院的发生风险,改善患者的长期预后.

Preoperative carbohydrates (CHO) supplement has been widely investigated in nondiabetic patients undergoing a variety of surgeries. It has been proved that preoperative CHO could alleviate postoperative insulin resistance (IR) and improve patients’ well-being in nondiabetic patients. However, it remains controversial whether preoperative CHO could yield similar effects in diabetic patients. Till now, seldom has the administration of preoperative CHO been investigated in diabetic patients and there are limited studies reporting IR and postoperative recovery of diabetic patients undergoing cardiac surgery. We present a prospective, single-center, single-blind, randomized, no-treatment controlled trial of preoperative CHO on diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB). A total of 62 patients will be enrolled and randomized to either Group CHO or Group control (CTRL). Patients in Group CHO will consume CHO fluid containing 50 g carbohydrates orally the evening before surgery (20:00–24:00) while their counterparts in Group CTRL will be fasted after 20:00 the evening before surgery. The primary endpoint is postoperative IR assessed via homeostasis model assessment (HOMA). The secondary endpoints are postoperative levels of potential mediators relating to IR including inflammatory factors and stress reaction characterized by serum cortisol. Exploratory endpoints are in-hospital clinical endpoints. Continuous variables will be compared by Student’s t-test or Mann-Whitney U test. Categorical variables will be compared with χ2 test or Fisher’s exact test. All tests in the present study are two-tailed and P<0.05 is considered statistically significant. All analyses will be performed with R 4.0.4. This is the first prospective randomized controlled trial of preoperative CHO in diabetic patients undergoing cardiac surgery, with the hypothesis that preoperative CHO could improve postoperative IR and promote postoperative recovery. The research may assist in improving the clinical outcomes of diabetic patients undergoing OPCAB. The trial has been prospectively registered with ClinicalTrials.gov ( https://register.clinicaltrials.gov ) and Chinese Clinical Trial Registry ( http://www.chictr.org.cn ). Registry number is NCT05540249 and ChiCTR2000029664 respectively. Registered on Sept. 14, 2022. Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, China.

目的 评价气管插管拔除时间对体外循环冠状动脉旁路移植患者术(CABG)后谵妄的影响.方法 回顾性分析阜外医院外科SICU2020年1月至12月行单纯行体外循环CABG的患者资料,包括基本情况、基础疾病、术前超声射血分数(EF)值、术前血肌酐值,术中体外循环时间及阻断时间,术后呼吸机使用时间,拔管时间、ICU停留时间以及术后谵妄发生率.结果 共495例患者纳入研究,其中夜间拔管组54例,对照组441例.夜间拔管组患者年龄[(56.5±8.8)岁比(61.3±8.1)岁]、体外循环时间[(103.2±33.5)min比(126.2±47.2)min]、阻断时间[(75.0±28.3)min比(91.7±33.7)min]及呼吸机使用时间[(12.5±5.0)min比(18.6±12.9)min]均小于对照组,差异具有统计学意义(P<0.05).夜间拔管组20例发生术后谵妄(37.0％),而对照组85例发生谵妄(20.5％),χ2=9.082,P=0.004.多因素logistic回归分析结果夜间拔管为冠状动脉旁路移植术后谵妄的独立危险因素(OR=4.155,95％CI 2.118～8.151,P=0.001).结论 夜间拔管增加CABG后患者谵妄的发生率.

44岁男性患者，因饱餐后胸闷发作频繁，诊断为冠状动脉瘘，经全麻体外循环下冠状动脉瘘修补术治疗后效果良好。冠状动脉瘘是一种少见的心脏畸形，单支冠状动脉瘘比较常见，双支冠状动脉瘘比较罕见；而前降支和回旋支共干瘘入右心室流出道同时合并巨大瘤样冠状动脉瘘更为罕见。本例是生活在云贵高原的少数民族，独特的地域、生活习惯以及复杂的病变为诊治过程提供了一些思考。

目的 总结现有文献,为原发性血小板增多症(essential thrombocythemia,ET)患者行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)提供经验.方法 结合本院ET病例检索中国知网、万方数据、维普网、中国生物医学网及PubMed等数据库,下载有关ET患者行CABG的个案报道,提取信息并总结经验.结果 共纳入15篇相关文献,其中男性19例,女性6例.CABG21例,主动脉瓣置换术(aortic valve replacement,AVR)+CABG 4例.5例患者术后发生严重并发症,其中4例术前血小板计数(blood platelet count,BPC)≥800×109/L,1例术后植入左心室辅助装置(left ventricular assist device,LVAD)、心脏移植,1例因室颤、心脏停搏死亡.结论 ET患者行CABG时易发生血栓或/和出血并发症,围手术期处理应包括降血小板治疗、预防血栓及心肌血运重建.

This case highlights the importance of coordinating with cardiopediatricians or congenitalists in the evaluation and treatment of ASD.

目的 比较体外与非体外循环冠状动脉旁路移植术(CABG)对患者术后谵妄发生率的影响.方法 回顾性分析阜外医院外科重症监护室(SICU)2020年1月至2021年4月收治的单纯行CABG患者信息,根据手术方式分为体外循环组和非体外循环组.比较两组患者的基本资料、基础疾病,术前超声射血分数(EF)值和术前血肌酐水平.终点指标为两组患者住院期间的谵妄发生率.结果 共607例患者纳入本研究,其中体外循环组495例,非体外循环组112例.两组患者年龄、性别比例、基础疾病(高血压、糖尿病、既往卒中史)、术前最后一次EF值、术前血肌酐值均无统计学差异.术中平均搭桥个数两组无统计学差异,体外循环组平均转机时间(123.7±46.8)min,主动脉阻断(89.9±33.6)min.术后呼吸机使用时间两组无统计学差异.ICU停留时间体外循环组高于非体外组[(3.0±1.8)d比(2.5±1.7)d,t=2.603,P=0.009].术后主要不良心脑血管事件(MACCE)发生率及连续性肾脏替代治疗(CRRT)两组均无统计学差异.体外循环组105例患者发生谵妄(21.2％),非体外循环组14例发生术后谵妄(12.5％).基于倾向性评分的逆概率加权回归分析提示OR值为2.402(95％CI:1.337～4.317),P=0.004.结论 非体外循环冠状动脉旁路移植术可降低术后患者谵妄的发生率.

目的:旨在随访继发性三尖瓣反流采用不同策略分级治疗后的疗效,验证策略分级的可行性,并总结影响三尖瓣反流复发的因素.方法:选取左心瓣膜疾病合并继发性三尖瓣反流的患者217例.根据三尖瓣瓣环直径指数和瓣叶闭合高度,把三尖瓣反流情况分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四级,结合术前反流程度、肺动脉压力等选择最终三尖瓣成形方法.随访术后1周、术后近期(3～12个月)及术后中期(13～96个月)的三尖瓣功能.结果:共有Ⅰ级患者66例,30.3％未给于三尖瓣同期处理,63.6％采用线性Devega成形;Ⅱ级患者73例,82.2％采用线性Devega成形,17.8％使用成形环处理;Ⅲ～Ⅳ级患者78例,70.5％使用成形环.术后中期随访患者113例(52.1％),平均随访时间(45.0±21.9)个月.术后中期与术前比较,左心房前后径[(49.0±11.4)mm vs(53.5±12.7)mm]、肺动脉收缩压[(32.4±8.6)mmHg vs(49.1±18.7)mmHg,1 mmHg=0.133 kPa]、三尖瓣瓣环直径指数[(17.2±2.0)mm/m2 vs(23.0±3.7)mm/m2]和瓣叶闭合高度[(3.3±1.1)mm vs(4.5±2.1)mm]均明显减低(P均<0.0001).最终共9例患者再次出现中量及以上程度三尖瓣反流,1例是Ⅰ级患者,余下8例均是Ⅲ～Ⅳ级患者.结论:继发性三尖瓣反流采用不同策略分级治疗,可以获得较满意的术后疗效,避免患者术后严重反流复发,有效降低三尖瓣再次手术的可能性.

目的 对比大剂量即4 mg和常规剂量即2 mg匹伐他汀对冠状动脉旁路移植术(CABG)后早期代谢、安全性及预后的研究.方法 以单中心非盲随机对照的方式对152位受试者开展为期6个月的临床研究.结果 术后1周时,两组的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)及肌酸激酶(CK)较基线水平均有所升高,但组间差异未达到显著水平;术后6个月时两组的ALT、AST、CK、肌酐(SCr)及非糖尿病患者的空腹血糖(FPG)较基线水平无明显变化,组间亦无明显差别;术后6个月时,两组的总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)较基线水平均明显降低(P＜0.05),且4 mg组较2 mg组降低更明显;4 mg组患者LDL-C下降超过50％的患者比例明显高于2 mg组(P＜0.05);两组患者的高密度脂蛋白胆固醇(HDL-C)较基线水平有所升高(P＜0.05),但组间无明显差异;两组的三酰甘油(TG)较基线水平有所降低,但无统计学差异.术后6个月时两组主要心血管事件(MACE)发生率无明显差异.结论 与常规剂量的匹伐他汀相比,大剂量匹伐他汀能够更明显地降低LDL-C水平,术后早期两组MACE发生率尚无明显差异.

临床资料患者,女,64岁,因“胸闷、胸痛10d,加重伴乏力、气促4d.”于2019年4月24日入我院.根据病史,患者4月10日突发心前区疼痛,外院诊断为广泛前壁心肌梗死,4月20日外院超声提示室间隔穿孔.入院查体:体温36.6℃,心率107次/min,呼吸频率20次/min,身高157 cm,体重68 kg,双肺底闻及湿性啰音,心前区闻及4/6全收缩期喷射样杂音,向胸骨右缘传导.辅助检查:心肌梗死三项:超敏肌钙蛋白(hsTnI):2.134 ng/mL;肌酸激酶同工酶(CK-MB):8.2ng/mL;肌红蛋白(MOY):188.8 ng/mL;氨基末端脑钠肽前体(NT-proBNP):25 951.4 pg/mL;生化提示肝酶及胆红素偏高;急诊心电图(ECG)示:窦性心律,V2 ～ V4 ST段抬高0.1 ～ 0.3 mV,Ⅱ～Ⅲ aVF导联可见病理性Q波,部分导联T波异常.经胸超声心动图(TTE)提示:左心室舒张末期直径(LVEDD)41 mm,射血分数55％,节段性室壁运动异常,前间隔及左室前壁室壁变薄,三层结构消失,运动幅度减低;室间隔穿孔,后室间隔近心尖部探及回声中断约18 mm(图1).

目的 探讨风湿性心脏病二尖瓣狭窄患者左心房大小及功能对继发性三尖瓣反流的影响.方法 选取2015年2月至2017年2月来阜外医院就诊的中度或重度风湿性心脏病二尖瓣狭窄患者67例,所有患者均行二尖瓣人工瓣膜置换手术,并于术前行超声心动图检查,均明确存在继发性三尖瓣反流.选取2016年于阜外医院就诊的门诊患者20例作为正常对照组,且均于就诊时行超声心动图检查.对研究组与正常对照组各项超声参数及左心房功能进行比较,对研究组左心房功能与三尖瓣结构及功能的相关性及继发性三尖瓣反流的影响因素进行分析.结果 研究组患者的三尖瓣瓣环直径指数与左心房面积变化率、排空分数及左心房平均应变呈强相关性(r=-0.65、-0.58和-0.59,P均<0.01).肺动脉收缩压与左心房面积变化率、排空分数及左心房平均应变呈较强的负相关性(r=-0.60、-0.58和-0.59,P均<0.01).Logistic多因素回归分析显示,三尖瓣瓣环直径指数、瓣叶闭合高度和肺动脉收缩压是影响术前继发性三尖瓣反流的相关因素(OR=1.916、2.382、1.059,95％CI:1.18～3.109、1.312～4.323、1.009～1.111,P均<0.05).Logistic回归分析发现肺动脉收缩压、左心房面积变化率和左心房平均应变是影响三尖瓣瓣环增大的危险因素(OR=1.044、0.875、0.809,95％CI:1.002～1.088、0.761～0.964、0.656～0.997,P均<0.05).结论 左心房扩大、功能减低参与了继发性三尖瓣反流的发生,左心房面积变化率和房壁平均应变减低会引发三尖瓣瓣环增大,从而导致三尖瓣反流的发生及加重.二维斑点追踪技术分析左心房应变可以提供更早期的左心房功能信息.

To review the patients with rheumatic tricuspid valve disease ( RT VD ) who were confirmed in cardiac operation and underwent tricuspid valve repair ,and summarize two and three‐dimensional echocardiography ( 2D‐ST E , 3D‐ST E ) characteristics of RT VD , and evaluate the surgical procedures and outcomes of RT VD . Methods Between December 2009 and December 2017 ,359 patients with rheumatic heart disease ( RHD ) underwent left‐sided valvular replacement were enrolled . During the operation , 56 patients with RT VD were confirmed . All patients underwent 2D‐ST E and 3D‐ST E preoperatively . The preoperative echo characteristics of RT VD and the procedure of tricuspid valvular repair were reviewed . T he morphology and function of tricuspid valve were followed after operation . Results Fifteen patients with RT VD were diagnosed by transthoracic echocardiography( T T E) preoperatively .Eight patients were presented tricuspid stenosis . T ricuspid annulus diameter [ ( 40 .3 ± 5 .6 ) mm ] , tethering distance [ ( 5 .9 ± 2 .2) mm ] ,and pulmonary artery systolic pressure [ ( 46 .3 ± 15 .9) mm Hg ( 1 mm Hg＝0 .133 kPa) ] were measured by echocardiography ,preoperatively . M oderate and severe tricuspid regurgitation were presented in 32 patients( 57 .1% ) . All patients underwent tricuspid valvular repair . During the mean follow‐up ( 78 .9 months) ,tricuspid annulus diameter was reduced and tricuspid regurgitation was relieved . Recurrent tricuspid regurgitation occurred in 8 patients( 14 .3% ) . Conclusions Preoperatively 2D‐STE and 3D‐ST E need to evaluate tricuspid valve very carefully . Compared with functional tricuspid regurgitation , RTVD has some characteristics ,including more serious tricuspid reflux grade ,higher tethering distance ,the mismatch between tricuspid reflux degree and tricuspid anmular diameter or pulmonary artery pressure . T ricuspid valve repair shows better early and mid‐term outcomes .

三尖瓣反流(tricuspid regurgitation,TR)是最常见的心脏瓣膜病之一,根据病因可将其分为原发性三尖瓣返流(primary TR)和继发性三尖瓣反流(secondary or functional TR),其中继发性三尖瓣远比原发性三尖瓣返流更为多见,多与右心形态学变化、瓣环的扩张、右心室的功能下降相关,亦或是继发于左心的瓣膜性疾病、房颤或者肺动脉高压.基于以上原因,外科手术的主要目的是通过缩小扩张的瓣环以及修复其原有的结构形态尽可能恢复三尖瓣的功能.本文针对各大指南及临床研究分析了如下两个问题:在二尖瓣手术时是否应该同时行三尖瓣手术？在不同患者中,应该选择什么手术方式来达到最佳手术效果呢?

Background. This study aims to compare the midterm outcomes of left ventricular reconstruction with those of left ventricular reconstruction plus mitral valve surgery in patients with left ventricular aneurysm due to anterior myocardial infarction and moderate mitral regurgitation. Methods. A total of 523 patients (75 who underwent left ventricular reconstruction plus mitral valve surgery and 448 who underwent left ventricular reconstruction) with concomitant moderate mitral regurgitation were included in the study population. All-cause mortality was considered the primary endpoint. Major adverse cardiovascular and cerebrovascular events, including death, myocardial infarction, stroke, and subsequent mitral valve surgery, were considered secondary endpoints. Multivariable proportional hazards Cox regression models were used to assess the associations between groups and outcomes. In the sensitivity analysis we excluded patients who did not undergo coronary artery bypass graft and repeated the statistical analysis above. Results. The median follow-up time among all patients was 41 months. There was no significant difference between the left ventricular reconstruction plus mitral valve surgery and the left ventricular reconstruction groups with regard to all-cause mortality (P = .208) and major adverse cardiovascular and cerebrovascular events (P = .817) after adjustment for covariates. In the sensitivity analysis there was no significant difference between the left ventricular reconstruction plus mitral valve surgery and left ventricular reconstruction groups with regard to all-cause mortality (P = .158) and major adverse cardiovascular and cerebrovascular events (P = .651) after adjustment for covariates. Conclusions. The clinical outcomes of left ventricular reconstruction are comparable with those of left ventricular reconstruction plus mitral valve surgery in patients with left aneurysm and moderate mitral regurgitation. (C) 2020 by The Society of Thoracic Surgeons

目的:探讨术中经食管超声心动图对心脏瓣膜置换术后即刻人工瓣膜功能异常的诊断价值.方法:回顾性分析2011年4月至2016年9月我院心脏瓣膜置换术后即刻急性人工瓣膜功能异常患者11例资料,总结术中经食管超声心动图结果,并与手术结果进行对照分析.结果:11例患者中,机械瓣置换术8例,生物瓣置换术3例.术中经食管超声心动图显示,瓣膜功能异常包括人工瓣膜梗阻(7例)及瓣膜关闭不全(4例).术中经手术证实,人工瓣膜梗阻原因包括:残留血栓、残留腱索、保留二尖瓣后叶、主动脉瓣下隔膜、机械瓣离体瓣叶开放受限;人工瓣膜关闭不全原因包括:生物瓣瓣叶脱垂、缝线勒住生物瓣瓣脚及瓣膜内源性因素.11例患者再次接受手术,其中6例更换新的人工瓣膜,其余5例去除梗阻原因,所有患者均未再次出现人工瓣膜功能异常,住院期间无患者死亡.结论:经食管超声心动图可及时确认心脏瓣膜置换术后即刻人工瓣膜功能异常,协助判别内源性因素并指导外科补救.

BACKGROUND:The incidence of Ebstein's anomaly is extremely low, and except for the Mayo Clinic, no cardiac center has reported on a sufficient number of patients. The aim of our study was to report the outcomes of Ebstein's anomaly patients treated with tricuspid valvuloplasty (TVP) or tricuspid valve replacement (TVR).METHODS:TVP or TVR was performed in 245 patients from July 2006 to April 2016. We reviewed patients' records and contacted patients via outpatient service and over the telephone.RESULTS:The mean follow-up time was 43.6 ± 32.6 months, and 224 (91.4%) patients underwent follow-up. The mean operative age was 31.2 ± 15.7 years. TVR was performed in 23 patients, and TVP was performed in 201 patients. The 30-day mortality rate was 1.3%, and the overall survival rate was 97.9% at 5 and 10 years. The early mortality rate of the TVP group was lower than that of the TVR group (0.5% vs. 8.7%, P = 0.028), and the overall mortality rate of the TVP group was lower than that of the TVR group, without statistical significance (1.0% vs. 8.7%). After propensity score matching, the rates of mortality and New York Heart Association class ≥ III were lower in the TVP group than those in the TVR group without statistical significance. Seven patients with Type B Wolff-Parkinson-White (WPW) syndrome underwent one-stage surgery, and arrhythmias disappeared. Six patients suffered from episodes of left ventricular outflow tract obstruction (LVOTO) during surgery. Severe LVOTO could be treated with reoperation of the atrialized right ventricle.CONCLUSIONS:Ebstein's anomaly patients treated with TVP or TVR can experience optimal outcomes with midterm follow-up. However, TVP should be the first-choice treatment. Optimal outcomes can be obtained from one-stage operation in patients with Type B WPW syndrome. Severe LVOTO during surgery might be related to improper operation of the atrialized right ventricle.

左心室流出道梗阻( LVOTO)的原因包括先天性左心室流出道狭窄、肥厚型梗阻性心肌病、二尖瓣副瓣[1]、二尖瓣成形术后等.但在三尖瓣下移畸形中关于 LVOTO 的报道罕见,Hirata等[2]报道了1 例三尖瓣下移畸形术前出现LVOTO,其主要是房化右心室导致室间隔基底部变形所致;Waterhouse等[3]也报道了1例因三尖瓣大量反流导致动态LVOTO的三尖瓣下移畸形患者.我们总结8例三尖瓣下移畸形矫治术中出现LVOTO的治疗经验,报道如下.