ABSTRACT
Objective:To comprehensively evaluate the tricuspid valve, right heart anatomical characteristics and related dynamic parameters in patients with different degrees of functional tricuspid regurgitation (FTR) using four-dimensional auto tricuspid valve quantitative(4D Auto TVQ), four-dimensional auto right ventricle quantitative(4D Auto RVQ), and four-dimensional auto left atrium quantitative(4D Auto LAQ), and to investigate the structural and functional changes of the tricuspid valve and right heart in them.Methods:Sixty-three patients with FTR diagnosed by echocardiography at the First Affiliated Hospital of Guangxi Medical University from February to July 2022 were prospectively selected as the case group, including 30 patients with mild FTR and 33 patients with moderate or above FTR, and 30 healthy subjects were selected as the control group. Transthoracic echocardiography was used for two-dimensional and three-dimensional image acquisition of the heart. The tricuspid regurgitation volume, left ventricular ejection fraction (LVEF), right ventricular global strain (RVGS) were measured by 2D images, and pulmonary artery systolic pressure (PASP) were measured from the tricuspid regurgitation pressure difference. The 3D images were imported into EchoPAC 204 to obtain the tricuspid valve, right heart structure and related dynamic parameters. The annulus area (AA), annulus perimeter(AP), spherical index (SI), annulus area change fraction (AC), coaptation point height (CPH), and tenting volume (TV) were measured by 4D Auto TVQ. The right atrial maximum volume (RAVmax) and right atrial minimum volume (RAVmin) were measured by 4D Auto LAQ. Right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) were measured by 4D Auto RVQ. After standardizing the dimension parameters with body surface area (BSA), the differences in the above parameters were compared between the three groups, the correlation between regurgitant volume and each parameter was compared by correlation analysis, and the independent factors of increased tricuspid regurgitant volume were investigated by univariate and multivariate linear regression analysis.Results:There were statistically significant differences in PASP, AA/BSA, AP/BSA, AC, TV, RAVmax/BSA, RAVmin/BSA, RVFAC, RVGS, and TAPSE between the three groups (all P<0.05). There were statistically significant differences in LVEF, CPH, RVEDV/BSA, and RVESV/BSA in the moderate and above FTR group compared with the control and mild FTR groups (all P<0.05). Correlation analysis showed that RAVmin was the most highly correlated with tricuspid regurgitant volume ( r=0.875, P<0.001) and TV and end-systolic annulus area(ESAA) were highly correlated with tricuspid regurgitant volume ( r=0.747, 0.683; both P<0.001) in patients with FTR. Multifactorial linear regression showed that RAVmin, TV and regurgitant volume were independently positively correlated (β=0.721, 0.205; both P<0.05). Conclusions:The four quantification technique can provide valid structural and functional information by quantifying the tricuspid valve as well as the right heart in patients with FTR, and RAVmin and TV are independent correlates of increased tricuspid regurgitant volume.
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This paper reports our experience on the management of 617 cases of thoracic injuries from 1949 to 1981. Among them, 515 cases were closed chest injuries and 102 cases open injuries. The mortality rate was 3.7%. The problems over the management of multiple double fracture of ribs, the indication for emergency thoracic operation and selected period, operation, as well as the mechanism, diagnosis and treatment of post-thoracic crushing injury encephalopathy were discussed.
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The use of flexible stent was proved very effective in reduction of loading stresses and in increase of durability of the tissue prosthesis.In order to study suitability of such a stent.a serial studies have been carried out in our hospital since 1978.The frame was made of acetal copolymer.The three posts of the frame were in equal distance with 15mm in height.The flexible stent was reinforced by application of a thin and small stellite ring fitted onto the annulus and covered with knitted Dacron cloth.A silastic foam ring was enclosed within the sewing ring which permits elasticity.Serial tests of the flexible stent pertaining to its antifatigue.anticreep.tensile strength, elasticity, chemical property, biological property have been made.These tests demonstrated that both the physical and chemical properties of the stent were stable, when exerting a pressure of 130mmHg evenly on the valve, the posts deflected towards the center from 0.9 to 1.0mm.while the deflection of the steel wire stent and stainless steel stent being 0.2mm and 0.5mm respectively.Histoio-gical examination of acetal copolymer-implanted tissue showed only slight reaction.According to the above data, the clinical use of the flexible stent bioprosth-esjs was therefore considered suitable.From October 1980 to March 1981, 14 patients had undergone mitral valve replacement and 1 died of heart failure.The 13 survivals for 4-10 months after operation were followed up.The results revealed significant reduction of cardiac size in x-ray studies and which marked improvement of cardiac function.NO thromboembolism occured.
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This paper reported 15 patients with cardiac failure undergoing emergency heart valve replacement.According to the different clinical and pathological conditions, these cases were divided into three groups : (1)acute rheumatic pan-carditis; (2)acute attack of chronic heart failure;(3)acute bacterial endocarditis . There were 2 aortic valve replacements and 13 mitral valve replacements, 6 of the patients died early postoperatively and 9 of them remained long-term survivors,7 patients survived more than 1 year and resumed their work.The indications for emergency heart valve replacement, characteristic features of operative technique, and postoperative managements were discussed.
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This paper presents the results and experience in 124 consecutive elective mitral valve replacements done between July-1980 and March-1983 with Shanghai-made tilting disc without early mortality.In this series, patients in grade III and IV were 96.78%, in whom 66% suffered from moderate and severe pulmonary hypertension. It denotes that the excellent operative results were not due to the choice of patients with light illness. The authors conclude that it is closely related to the following measures : (1) experienced surgeons'taking part in operations; (2) close watch to patients by surgeons and skilled nurses in intensive care unit; (3) the myocardial protecton including pre、intra, and postoperative managements supporting and improving, the cardiac function; (4)emphasis on the importance of postoperative circulatory support; (5)postoperative respiratory support and strict adherence to the ex-tubation criteria for every patient; (6)adequate anticoagulant therapy; and (7)the use of digitalis and /or diuretics in routine and successive treatment.