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@#Objective To summarize the clinical result of a combined technical system for bicuspid aortic valve (BAV) repair. Methods Patients who diagnosed as BAV and sever aortic regurgitation (AR) underwent a strategy of combined repair technics including annuloplasty, sinus plasty, leaflet plasty, sinus-tubular junction (STJ) plasty depending on anatomy pathological characteristics between October 2019 and January 2021 were enrolled. The clinical data of the patients were analyzed. Results A total of 17 patients were enrolled. There were 11 males and 6 females with an average age of 18-49 (32.4±13.6) years. Fifteen patients had typeⅠand 2 patients had typeⅡBAV according to Sievers classification. Annuloplasty was applicated in 13 patients, sinus plasty in 8 patients, leaflet plasty in 17 patients, and STJ plasty in 11 patients, respectively. The cardiopulmonary bypass (CPB) time was 95 (84, 135) min, aortic cross-clamping time was 68 (57, 112) min, and the ICU stay time was 17 (12, 25) h. After the operation, mild AR was presented in 14 patients, moderate AR in 1 patient and severe AR in 2 patients. The latter 3 patients underwent second operation under CPB, after then, 1 patient had mild AR and 2 patients had moderate AR. The follow-up time was 13.1±4.6 months. At the latest follow-up, 12 patients had mild AR and 5 patients had moderate AR, and no patient had reoperation. Conclusion A combined technical system for BAV repair can be used effectively and safely with an acceptable short and middle-term result.
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Objective:To summarize the construction of a technics system of aortic valve repair in adult patients with aortic regurgitation(AR).Methods:From March 2013 to May 2020, aortic valve repair was performed in 79 patients. In which 43 cases underwent simple technics such as subcommissural annuloplasty, leaflet plication etc. Cases done before May, 2018 were defined as A group, yet the other 36 cases underwent a routine repair technics system including annuloplasty, sinusplasty, cuspidplasty and sinotubularplasty after then as B group. The general data and the operation procedure, also the follow-up were analyzed.Results:In group A, there were 2 cases with simple aortic valve repair and 41 cases with other intracardiac operations. In group B, 23 patients had aortic valve repair alone and 13 patients had other intracardiac operations. Group A mostly adopts the technologies of subjunctional involution and ridge suspension. In group B, flap ring molding, flap leaf molding, sinus tube joint molding and other technologies were used. Postoperative reflux was reduced to moderate or mild in most patients in group A. In group B, postoperative reflux was reduced to mild in most patients. There were 7 cases of severe reflux in group A, and 2 cases of severe reflux were worse after repair than before surgery. In group B, 8 patients had no effective repair, and 3 patients continued to have satisfactory repair after the second turnaround. Aortic regurgitation at 1 year(or the last echocardiographic follow-up) after surgery: 15 patients in group A were mild, 17 were moderate, and 4 were severe; In group B, 2 patients underwent revalve replacement within 1 year, and the remaining 29 patients were moderate and mild, 20 cases were moderate, 7 cases were moderate, and 2 cases were severe.Conclusion:In some adult moderate and severe AR cases, a routine combined repair system can be applied to increase success rate of repair, and shows a good short and mid-term result.
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Objective:To evaluate the mid-term outcomes of patients with rheumatic heart disease who underwent aortic valve repair surgery in a prospective cohort.Methods:From January 2016 to December 2020, a total of 54 patients with rheumatic heart disease underwent aortic valve repair surgery in Beijing Anzhen Hospital, with an average age of (50.61±13.29) years, including 29 females (53.7%). There were 31 patients (57.4%) had pure aortic insufficiency, 2 patients (3.7%) had pure aortic stenosis and 21 patients (38.9%) had mixed lesion. During the same period, 43 patients (80.0%) underwent mitral valve surgery, 36 patients (66.7%) underwent tricuspid valve surgery, and 20 patients (37.0%) underwent atrial fibrillation radiofrequency ablation.The follow-up period was from 1 month to 61 months (median follow-up was 25 months). Paired rank-sum test was used to compare the differences in continuous variables among subjects, and Kaplan- Meier method was used to analyze the clinical outcomes during the follow-up period. Results:Proportion of moderate and severe aortic regurgitation Preoperatively was higher than that of discharge data, aortic valve orifice maximum velocity and left ventricular end-diastolic diameter were significantly lower than discharge data (all P<0.05). The 5-year survival rate was (96.1±2.7)% (2 patients died). The 5-year freedom from reoperation after aortic valve repair was (89.5±4.5)%(5 patients underwent redo surgery). The 5-year freedom from valvular-related complications was (91.3±4.2)%(3 patients suffered from complications). Conclusion:Aortic valve repair surgery for rheumatic aortic valve disease is feasible and has excellent early and mid-term results, it can be a reliable treatment option.
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Objective@#Mitral valve replacement is more frequently performed in elder patients with rheumatic valve diseases. Mitral valve repair may be feasible in young patients with suitable anatomy in rheumatic mitral valve disease, but still controversial in elder patients. Our study was to compare mitral repair to bioprosthetic replacement in patients aged 60 years or older.@*Methods@#Eighty two patients(age ≥60 years) underwent mitral valve surgery(mitral repair or bioprosthetic replacement)in our single institution from January 2014 to January 2016 were reviewed, including 25 cases of repair(MVP) and 57 cases of bioprosthetic replacement(MVR). 5 years follow-up oganalysis.@*Results@#Mean age in MVP and MVR was 64.43 years and 67.28 years, respectively. There were no statistically differences in extracorporeal circulation time(P=0.99) and aorta blocking time(P=0.88); the operative mortality rate in MVR was 5.3% while none in MVP(P=0.24). During follow-up 6 deaths happened in MVR, 4 of them died from MACE while the other 2 died from other causes. There was no death in MVP(P=0.17). No redo or other complications were found during follow-up.@*Conclusion@#In patients aged 60 years or older with rheumatic mitral valve disease, mitral repair is associated with a same perioperative and mid-term result compared with bioprosthetic replacement. Rheumatic mitral valves could be repaired in elderly patients.
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Objective:Mitral valve replacement is more frequently performed in elder patients with rheumatic valve diseases. Mitral valve repair may be feasible in young patients with suitable anatomy in rheumatic mitral valve disease, but still controversial in elder patients. Our study was to compare mitral repair to bioprosthetic replacement in patients aged 60 years or older.Methods:Eighty two patients(age ≥60 years) underwent mitral valve surgery(mitral repair or bioprosthetic replacement)in our single institution from January 2014 to January 2016 were reviewed, including 25 cases of repair(MVP) and 57 cases of bioprosthetic replacement(MVR). 5 years follow-up oganalysis.Results:Mean age in MVP and MVR was 64.43 years and 67.28 years, respectively. There were no statistically differences in extracorporeal circulation time( P=0.99) and aorta blocking time( P=0.88); the operative mortality rate in MVR was 5.3% while none in MVP( P=0.24). During follow-up 6 deaths happened in MVR, 4 of them died from MACE while the other 2 died from other causes. There was no death in MVP( P=0.17). No redo or other complications were found during follow-up. Conclusion:In patients aged 60 years or older with rheumatic mitral valve disease, mitral repair is associated with a same perioperative and mid-term result compared with bioprosthetic replacement. Rheumatic mitral valves could be repaired in elderly patients.
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Objective To determine the feasibility of OZAKI procedure aortic valve neo-cuspidization(AVneo) for the treatment of aortic valve disease in our institution.Methods Twelve consecutive patients from November 2015 to October 2016 received AVneo in our single center are retrospected.Their mean age was(41.3 ± 16.9) years old.There were 11 males and 3 females.3 patients had aortic stenosis and 11 patients had aortic insufficiency.Autologous pericardium was used to reconstruct 3 aortic leaflets independently.The distance between each commissure was measured by a specific sizer to decide the size of each leaflet.Suturing the pericardial leaflets onto each aortic annulus.Results There was no perioperative mortality.No operations converted to prosthetic valve replacement.1 patient experienced IABP therepy for 2 days,for ventricular tachycardia repeatedly happened when cardiac rebeating intraoperation.Echocardiography one week after surgery showed an average maximum flow velocity of aortic valve of(162.9 ± 34.2) cm/s,average peak pressure gradient of(11.1 ± 4.9) mmHg (1 mmHg =0.133 kPa).Except 1 patient had moderate regurgitation after surgery,the rest of 13 patients showed less than mild aortic regurgitation.Conclusion OZAKI procedure AVneo provides good short-term results in patients with various aortic valve disease.
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BACKGROUND:Stem cell transplantation provides a new approach to treat chronic renal disease.Specific marking and in vivo tracing of stern cells are the basis of studies in this field.However,the marking methods appropriate for all cells remain uncertain.OBJECTIVE:To observe the in vivo location and differentiation of 4',6-diamidino-2-phenylindole (DAPI) and green fluorescence protein (GFP)-Iabeled cells in adriamycin nephrosis rats so as to explore an efficient labeling and tracing method for metanephric mesenchymal cells (MMCs) derived from embryonic rats.DESIGN,TIME AND SETTING:Grouping comparative observation was performed at the Second Xiangya Hospital of Central South University from April to December 2007.MATERIALS:A total of 60 female SD rats,weighing 180-220 g,of dean grade,were used to establish models of adriamycin nephrosis.METHODS:DAPI and MMCs infected with GFP and DAPI were respectively injected into addamycin nephrosis via the tail vein.DAPI and GFP distribution in the frozen sections was detected at 1,3,and 5 weeks,postoperatively.In addition,GFP expression in renal tissues was detected by ABC immunoenzymatic staining method.MAIN OUTCOME MEASURES:DAPI and GFP-labeled Cell grafts in adriamycin nephrosis rats were compared.The changes of GFP-transfected MMCs at different time points were observed.RESULTS:DAPI positive cells were observed in tubular structures after 1 weeks of injection of DAPI-labeled cells and DAPI alone,and remained existing at 5 weeks,but the florescence was reduced with time.GFP-transfected MMCs were able to survive and integrate into tubular structures after 1 week,and remained existing at 5 weeks.Moreover,the fluorescence was not reduced.ABC immunoanzymatic staining showed that only a few GFP-positive MMCs appeared in glomerular tufts,and mainly distributed in cytoplasm.Semi-quantitative evaluation of GFP show that the positive cell rate in rats with early application was greater than that with advanced application,and the positive rate was increased with time.CONCLUSION:Liposome mediated GFP gene transfer was an efficient labeling in vitro and suitable tracing method for cell differentiation experiment in vivo,suitable for short-term tracing and observation of transplanted cells.
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Objecfive To detect the functional repair of metanephric mesenchymal cells (MMCs) transplantation in adriamycin (ADR)-induced glomerulopathy rats. Methods A total of 90 Sprague-Dawley female rats were randomly divided into three groups:ADR group (n=40,rats were injected via the tail vein with O.25 mg ADR/100 g body weight on days 1 and 21),ADR- MMCs group(n=40,rats were injected via the tail vein with 5×10~6-7×10~6 MMCs 8 weeks after the second ADR administration),control(n=10).All the rats were scarified 8 weeks after MMCsinjection.Pathology and collagen IV expression in renal tissue were examined.Moreover,matrix metalloproteinases 2 (MMP-2) and matrix metallopmteinases 9 (MMP-9) expression in the renal tissue were also detected with immunohistochemistry,and quantity analysis of protein and gene was further demonstrated with Westem blot and RT-PCR analysis,respectively. Results There were no significant differences in tubulointerstitial injury score and glomerulosclerosis degree between ADR group and ADR-MMCs group(P>0.05).Compared with ADR group,collagen Ⅳ and MMP-2 expression decreased, MMP-9 expression incrased in renal tissue of ADR-MMCs group, and the difference was significant (P<0.05). Conclusion MMCs transplantation may have potentially therapeutic effect on renal tissue fibrosis of adriamyein-induced glomerulopathy in rats, and the signaling pathways of MMPs appear to be involved in these processes.