ABSTRACT
ObjectiveTo analyze whether association of edge to edge valve repair to artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation (TR).MethodsFrom April,2001 to May,2010,41 patients underwent tricuspid valve repair to treat severe TR were studied.Twenty-one patients were done artificial ring annuloplasty alone (group R) and twenty patients were done artificial ring annuloplasty associated with edge to edge valve repair ( group E).All the patients received echocardiography before surgery,before discharge and in mid and long-term follow-up.The ratio between TR jet area (TRA) and right atrial area (RAA) was used to quantitatively evaluate the seriousness of TR.Movement of tricuspid valve leaflets,tricuspid valve orifice area,pulmonary artery pressure ( PAP),left ventricular ejection fraction ( LVEF) were obserbed to evaluate heart function.ResultsAt discharge in group R,no or trivial TR was presented in 7 patients,mild TR in 12 patients and moderate TR in 2 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild and moderate TR.While in group E,no or trivial TR was presented in 13 patients and mild TR in 7 patients.The follow-up ranged from 6 months to 100 months[average (54.8 ±26.7) months].In group R,no or trivial TR was present in 5 patients,mild TR in 11 patients,moderate TR in 4 patients and severe in 1 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild to severe TR.Redo tricuspid valve repair was done in one patient in group R for recurrent severe TR and the edge-to-edge valve repair was utilized.In group E,no tricuspid stenosis was found.No or trivial TR was presented in 10 patients,mild TR in 9 patients and moderate TR in 1 patient.The ratio of TRA/RAA of group R was significantly higher than that of group E (0.25 ±0.16 vs.0.13±0.10,P < 0.01).ConclusionAssociation of edge-to-edge valve technique to artificial ring annuloplasty was safe and effective for treatment of severe tricuspid regurgitation due to bad apposition of free edges of tricuspid leaflets and dilatation of tricuspid annulus,.It could decrease the incidence of residual tricuspid regurgitation and prevent the recurrence of severe tricuspid regurgitation.
ABSTRACT
Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe tricuspid regurgitation in patients with congenital heart disease. Methods From April 2001 to Mar. 2010, severe tricuspid regurgitation was corrected with a flexible band anuloplasty and edge-to-edge valve plasty technique in 14 patients with congenital heart disease. The age ranged from 7 years to 62 years [average (31.2 ± 16.1 ) years]. Congenital cardiac anomalies include: atrioventricular canal in 5 cases, secundum atrial septal defect in 6 cases, secundum atrial septal defect with mitral valve regurgitation in 2 cases and cor triatriatum in 1 case. Results No hospital death or postoperative morbidity occurred. No or trivial tricuspid regurgitation was present in 11 cases and mild tricuspid regurgitation in 3 cases at discharge. The follow-up ranged from 3 month to 97 months [average (51.6 ± 26.8 ) months]. No tricuspid stenosis was found. No or trivial tricuspid regurgitation was present in 5 cases. Mild tricuspid regurgitation was present in 8 cases, and moderate tricuspid regurgitation in 1 case at the latest followup. Conclusion Edge-to-edge valve plasty is an easy, effective and important procedure to correct severe tricuspid regurgitation in patients with congenital heart disease.
ABSTRACT
Objective To study the change of neurohormonal factors during CABG and find the effective perioperative treatments for coronary artery disease patients with high-risks. Methods Forty-eight patients were divided into on-pump CABG group(group A, n=23) and off-pump CABG group(group B, n=25). The clinical results were observed and blood samples were collected at six time-points. Angiotensin II(AG II), aldosterone(ALD), atrial natriuretic peptide (ANP), insulin, glucose and cTnI levels in plasma were measured respectively. Results The AG II levels in plasma increased in both groups and reached the peak at 6 h after operation in group A and 3 h after operation in group B, respectively. The peak level of ALD in plasma were at 6 h in group A, and 0 h in group B. The level of ANP in plasma was highest at 0 h in group A, and at the midoperation in group B. The insulin level in plasma was highest at 24 h in group A and at 6 h in group B. The insulin level at 24 h in group A was significantly higher than that in group B. The glucose level reached the peak at 3 h after operation in group A and at 0 h after operation in group B. The levels of AG II, ALD, ANP and glucose in plasma in group A were significantly higher than those in group B at any time-point. The cTnI levels were highest at 24 h in both groups. The cTnI levels in group A were significantly higher than group B at time-points. Conclusion CABG can produce hyperosmotic urinative effects and hyperaldosteronism, which in CABG group is strong and persistent effects due to the hyperosmotic urinative effects and hyperaldosteronism. In OPCAB group is light and short urinative effects mainly due to the hyperosmotic. ACEI, ARB and aldosterone antagonists should be used during the perioperation of CABG. During the early postoperative period, the plasma glucose should be well controlled and GIK solution with magnesium is needed.