Two kinds of artificial valve rings in the treatment of degenerative mitral regurgitation due to pure mitral valve ring expansion / 中国组织工程研究

BACKGROUND:Incidence of degenerative mitral regurgitation show a gradual increase tendency,but there is no report on degenerative mitral regurgitation due to pure mitral valve ring expansion in China.OBJECTIVE:To summarze the early and midterm outcomes of pure mitral valve annuloplasty in the treatment of degenerative mitral regurgitation due to pure mitral valve ring expansion. METHODS :Forty-eight patients with degenerative mitrlal regurgitation due to pure mitral valve ring expansion underwent pure mitral valve annuloplasty, including 23 cases treated with Carpentier-Edwards Physio ring and 23 with SJMTM rigid saddle ring.Affter discharge,echocardiography was used to evaluate heart function and mitral regurgitation degree during the follow-up.The outcomes were compared between the two groups. RWSULTS AND CONCLUSION:There was no early death after operation and all cases were cured and discharged.All patients were followed up for 3 months to 4years,and the cardiac function and mitral valve regurgitation were significantly improved (no mitral regurgitation in 36 cases,trivial regurgitation in 10 cases and mild mitral regurgitation in 2cases).According to NYHA grading,there were 32 cases of level 1 and 16 ceses of level Ⅱ. The echocardiography showed that postoperative left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, pulmonary artery systolic pressure and the ratio of regurgitation beam area to left atrial area were significantly lower than those before operation (P < 0.01). The left ventricular ejection fraction increased greatly (P < 0.01). There was no ring rupture, ring avulsion and hemolysis. Postoperative transvalvular pressure was less than 3 mm Hg. However, there were no significant differences in the above-mentioned parameters between the Carpentier-Edwards Physio ring and SJMTM rigid saddle ring groups. The results suggest that the pure mitral valve annuloplasty is excelent in the treatment of degenerative mitral regurgitation due to pure mitral valve ring expansion, through the right surgical techniques and the right choice of artificial valve ring.

Artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation / 中国组织工程研究

BACKGROUND:Artificial chordae transplantation and saddle ring annuloplasty are the key steps in mitral valvuloplasty. However, there are no large-size studies addressing the safety, validity and efficacy of these treatments in China. OBJECTIVE:To summarize the efficacy and safety of artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation. METHODS:Eighty-five patients with degenerative mitral regurgitation underwent mitral valve repair with artificial chordae (Gore-Tex sutures) transplantation and saddle ring (SJMTM rigid saddle-shaped) annuloplasty from January 2009 to May 2013 in General Hospital of Shenyang Area Military Command, China. Operative technique included simple artificial chordae transplantation in 41 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 22 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet and sliding technique in 23 cases. Al cases received saddle ring annuloplasty. RESULTS AND CONCLUSION:Fol ow-up after treatment was done among 78 patients for 6 months to 4 years, with a fol ow-up rate of 91.7%(78/85). Among the 78 cases, one case died of cerebral infarction after 13 months, one died from accident, and the remaining 76 were alive. According to the evaluation of cardiac function (NYHA), 59 cases were in grade I and 17 cases were in grade II. Color ultrasound displayed that, no regurgitation was found in 67 cases, and mild regurgitation in 9 cases. The echocardiography showed that postoperative left atrium diameter (P<0.05 or P<0.01), left ventricular end-diastolic diameter (P<0.05 or P<0.01), left ventricular end-systolic diameter (P<0.05 or P<0.01), and the ratio of regurgitation beam area and left atrial area (P<0.05 or P<0.01), mean pulmonary artery pressure (P<0.05 or P<0.01) were significantly decreased compared with that before operation. Ejection fraction was significantly increased after operation (P<0.05 or P<0.01). No systolic anterior motion occurred. The postoperative complications included sinus bradycardia in 12 cases and paroxysmal supraventricular tachycardia in 25 cases, late cardiac tamponade in 1 case at 1 week postoperatively, and pacemarker implantation in 1 case (who exhibited bradycardia-tachycardia syndrome before operation). There was no ring rupture, ring avulsion, hemolysis, left ventricular outflow tract infarction and artificial chordae rupture or splitting. No cases needed reoperation on valve replacement. Application of artificial chordae transplantation and saddle ring annuloplasty is a safe and effective means for treating degenerative mitral regurgitation, with excellent midterm outcomes.

Analysis of mitral artificial chordae transplantation in 105 cases / 中国医师进修杂志

Objective To summarize the experience of application of artificial chordae transplantation in mitral valve repair.Methods One hundred and five patients with mitral regurgitation due to mitral degeneration,underwent mitral valve repair with artificial chordae transplantation.Operative technique included simple Gore-Tex artificial chordae transplantation in 25 cases,artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 67 cases,artificial chordae transplantation plus quadrangular resection of the posterior leaflet and Sliding technique in 13 cases.Results No early death occurred after operation.The postoperative complications were caused in 30 patients including sinus bradycardia in 8 cases,supraventricular tachycardia in 20 cases,late cardiac tamponade in onecase,pacemarker implantation in one case.Hospital time was 9-21 (14 ±4) d.Follow-up was done to 96 patients for 3 months to 5 years with a follow-up rate of 91.4％(96/105).Among 96 cases,one died of cerebral infarction after 13 months,one died from accident while the remaining were alive,74 cases were with cardiac function (NYHA) of grade Ⅰ and 20 cases with grade Ⅱ.No regurgitation was found in 92 cases,mild regurgitation in 2 cases.There were no artificial chordae ruptures.Conclusions The key to improve the early and midterm results of artificial chordae transplantation are to choose patients strictly,to grasp proper surgical skills,to do a good job in intraoperative shaping effect evaluation and the myocardial protection during extracorporeal circulation.

Individualized treatment prevents patient-prosthesis mismatch after aortic valve replacement with small aortic annulus / 中国组织工程研究

BACKGROUND:It is so difficult to have aortic valve replacement with smal aortic annulus. Improper treatment may lead to patients with valvular mismatch phenomenon, and thus make left ventricular outflow tract obstruction, increase transvalvular pressures, cause cardiac hypertrophy secondary to increased left ventricular afterload and even congestive heart failure. OBJECTIVE:To summarize the treatment strategy for preventing valvular mismatch phenomenon caused by smal aortic annulus after aortic valve replacement. METHODS:Eighty-five patients with smal aortic annulus underwent aortic valve replacement surgery. 19 mm SJM Regent valve was applied to the patients with orifice diameter>17 ≤ 19 mm;to the adult patients with orifice diameter ≤ 17 mm, we performed bovine pericardial patch enlargement of the smal aortic annulus and valve replacement using 19 mm SJM Regent valve. For those with orifice diameter>19 ≤ 21 mm, we selected 21 mm Hancock II ultra biological valve for valve replacement. Effective orifice area index, left ventricular mass index, inter-ventricular septal thickness, left ventricular wal thickness, trans-valvular peak velocity, the pressure difference across the valve and trans-valvular mean pressure were measured through echocardiography. After discharge, patients were fol owed up in out-patient clinic and evaluated regularly by echocardiography. RESULTS AND CONCLUSION:There were no early deaths after operation and al cases were cured and discharged. Fol ow-up time was between 6 months and 3 years. The main complications included low cardiac output syndrome in two cases, reoperation due to bleeding in one case, and ventilator dependence in two cases. No cases occurred in cerebral complications such as cerebral hemorrhage or cerebral thrombosis, and no valvular dysfunction or card flap appeared. There was no bovine pericardium tearing, thrombosis, calcification, tumor-like bulge, infection or immune reactions. A total of 81 cases were fol owed up and the fol ow-up rate was 95%(81/85). There were NYHA class grade I in 65 cases, and grade II in 16 cases. Peak velocity across the aortic valve and the mean pressure were significantly decreased, effective orifice area index increased significantly, left ventricular mass index, left ventricular wal thickness and the thickness of the inter-ventricular septum were significantly reduced compared with pre-operation, and no valvular mismatch phenomenon occurred. Compared 21 mm Hancock II ultra biological valve with 21 mm SJM Regent group, the former got a better peak velocity and mean trans-valvular pressure, and better left ventricular remodeling index. Body weight and body surface area were significantly increased in 19 mm Regent valve group after operation. The results suggest that individualized treatment strategies should be taken to prevent the occurrence of postoperative valvular mismatch phenomenon for patients with smal aortic annulus.

Early hemodynamic evaluation of aortic valve replacement with Hancock Ⅱ Ultra valve / 中华胸心血管外科杂志

Objective To study the aortic valve replacement with Hancock Ⅱ Ultra valve and its early hemodynamic results.Methods The 30 patients who received Hancock Ⅱ Ultra aortic valve replacement at our hospital were matched 1 ∶1 with 30 patients who received Hancock Ⅱ on variables known to affect hemodynamic measurements:size of valve,age,sex,and body surface area.Early postoperative transthoracic echocardiography was performed in all patients.Results 3 months postoperatively,Hancock Ⅱ Ultra valves had significantly lower transvalular gradients,velocity,left ventricle mass index and larger effective orifice area.Compared with Hancock Ⅱ valves,in ≤22 mm group,Hancock Ⅱ Ultra valves had significantly lower transvalular velocity[ (2.26 ± 0.05 ) vs ( 2.57 ± 0.06 ),t =2.07,P ＜ 0.05 ],lower transvalular mean gradients [(11.4 ±1.3) vs (13.1 ±1.5),t =2.09,P＜0.05],higher effective orifice area[ (0.79 ±0.13)vs(0.71 ±0.02),t =2.06,P＜0.05],lower left ventricle mass index[ (119.1 ± 11.1)vs(133.2 ±16.4),t =2.67,P ＜0.05] and bigger left ventricle outflow tract (20.4 ±0.3 vs 18.9 ±0.2,t =2.23,P＜0.05).Conclusion The Hancock Ⅱ Ultra valve has more favorable early postoperative hemodynamics than the Hancock Ⅱ,especially for the small aortic ring patients.

One-stage repair of aortic coarctation or interrupted aortic arch associated with cardiac anomalies through median sternotomy / 中华胸心血管外科杂志

Objective Study the management and outcomes of one-stage repair of aortic coarctation or interrupted aortic arch associated with cardiac anomalies through median sternotomy.Methods From July 2002 to June 2009,43 patients with aortic coarctation(34 cases)or interrupted aortic arch(9 cases)and associated with cardiac anomalies underwent one-stage repair.There were 27 males and 16 females.The age ranged from 5 months to 9 years and the body weight from 3.5 kg to 29.0 kg.The associated cardiac anomalies included ventricular septal defect in 42 patients,patent ductus arterious in 34,secundum atrial septal defect in 12,subaortic stenesis in 5,mitral valve regurgitation in 2 and double outlet of right vantricule in 1.All patients underwent one-stage repair through median sternotomy.The aortic continuity was reestablished by direct anastomosis between the descending aortic segment and aortic arch.Results There was one postoperative death.The causs was pulmonary hypertension and severe low cardiac output syndrome.The postoperative complications included severe low cardiac output syndrome in 3 patients,hypoxemia in 6,pneumonia in 11,atelectasis in 14,injury of recurrent laryngeal nerve in 19,and supra ventricular tachycardia in 23.34 patients were followed up from 3 months to 5 years and were in good condition without recoarctation.Conclusion The outcomes of early and medium term for one-stage repair of aortic coarctation or interrupted aortic arch and associated cardiac anomalies through median sternotomy is excellent.Technique of extended anastomosis between the descending aortic segment and aortic arch may reduce the incidence of recoarctation

A perfusion mode of the pulmonary artery during cardiopulmonary bypass / 中华胸心血管外科杂志

Objective Lung injury occurred during cardiopulmonary bypass as a result of both ischemic-reperfusion injury and systemic inflammatory response is critical for patients' recovery. This study was designed to establish a convenient and appropriate mode for pulmonary artery perfusion and evaluate its effects on the cardiopulmonary bypass-induced lung injury.Methods Fourteen healthy mongrel dogs were randomly assigned to a control group and a perfusion group, which were designed to simulate clinical cardiopulmonary bypass-induced lung injury. Pulmonary arteries were perfused with modified low-potassium dextran solution immediately after the initiation of pulmonary ischemia and before reperfusion, with a pressure of 15 to 20 mm Hg for the perfusion group. Pulmonary arteries of animals in the control group were not perfused. After pulmonary reperfusion, changes in the pulmonary function were evaluated. Results After pulmonary reperfusion, deterioration in the pulmonary function with various severity was identified in both groups. Pulmonary injury in the control group decreased significantly as manifested by a substantial elevation in PVR [with a change of ( 76 ± 7 ) %], decreased compliance [with a change of (30 ±4) %] and decreased oxygenation index [with a change of (45 ±5 ) %]. In contrast, the injury in perfusion group, as compared with that in the control group, was relatively moderate, with a lower PVR [with a change of ( 28 ± 3 ) %, P ＜0.01 )] ,a higher compliance [with a change of ( 12 ± 2 ) %, P ＜ 0. 01] and a better oxygenation index [with a change of (19 ± 2 )%, P ＜ 0.01]. Conclusion The pulmonary perfusion mode used in this experiment could relieve the cardiopulmonary bypass-induced lung injury and preserve pulmonary function effectively. It was expected that this perfusion mode could be used in the cardiosurgery practice expediently, without interfering with the scheduled operation proceeding obviously.

Levels of plasma endothelin, nitric oxide and atrial natriuretic peptide after cardiopulmonary bypass and influence of inhaled nitric oxide in patients with ventricular septal defect and pulmonary hypertension / 中华外科杂志

<p><b>OBJECTIVES</b>To assess the changes of the levels of plasma endothelin (ET-1), nitric oxide (NO) and atrial natriuretic peptide (ANP) after cardiopulmonary bypass (CPB) and the influence of inhaled nitric oxide in patients with ventricular septal defect (VSD) and pulmonary hypertension (PH).</p><p><b>METHODS</b>Sixty patients with VSD were enrolled in this study. They were divided into 2 groups: group A [no-PH group, mean pulmonary artery pressure (mPAP) < 20 mm Hg (1 mm Hg = 0.133 kPa) n = 20] and group B (PH group, mPAP > 20 mm Hg, n = 40). Group B was subdivided into two groups by randomized block, group B(1) (inhaled NO group, n = 20) and group B(2) (contrast group, n = 20). The plasma ET-1, NO, ANP concentrations were assayed at 24 h pre-operation and 0 h, 1 h, 5 h, 12 h, 24 h, 48 h after CPB.</p><p><b>RESULTS</b>The preoperative plasma ET-1, NO and ANP concentrations in group B were significantly higher than those in group A. In three groups, the plasma ET-1 concentration at 0 h after CPB was significantly higher than that at 24 h pre-operation, and the plasma NO concentration at 0 h after CPB was significantly lower than that at 24 h pre-operation. In group B, the plasma ANP concentration at 0 h after CPB was significantly higher than that at 24 h pre-operation. After CPB, the plasma ET-1 concentration in group B(1) decreased faster than that in group B(2), and the plasma NO concentration in group B(1) increased faster than that in group B(2). In group B, the preoperative plasma ET-1 concentration negatively correlated with the preoperative plasma NO concentration and positively correlated with the preoperative ANP concentration.</p><p><b>CONCLUSIONS</b>The broken dynamic balance of ET-1/NO may take part in generation and development of pulmonary hypertension. ANP acts as a favorable physiological regulating factor in the pathogenesis of pulmonary hypertension. CPB can regulate the level of ET-1 up and NO and ANP down while inhaled NO can cause the level of ET-1 down and the level of NO up.</p>