Sobrevida alejada de los pacientes con estenosis aórtica severa tratados con implante valvular percutáneo / Long-term survival of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe option for low, medium and high-risk patients with severe aortic stenosis (SAS). Aim: To analyze the clinical results and long-term survival of TAVI in our center. Material and Methods: Prospective analysis of 53 patients aged 73 ± 10 years with a Society of Thoracic Surgeons (STS) score of 7.3 ± 3.9%. Results: In 96% a transfemoral access was used and, in most patients, ProGlides™ as vascular closure device was used. General anesthesia and conscious sedation were used in 79 and 21% of cases, respectively. Fifty-three valves were implanted, 42 self-expandable (SEV) and 11 balloon-expandable (Edwards Sapiens). The implant was successful in 49 patients (92,4%). The transaortic gradient after TAVI was almost zero mmHg in all patients and one had a severe aortic regurgitation. Permanent pacemakers were needed in 17% of patients. Two patients had a pericardial effusion, and one had a major vascular complication. No strokes were recorded, and 30-day mortality was 3.7%. At long-term follow up (23.4 ± 21.6 months) the global survival was 85% and the rate of cardiovascular mortality was 5.9%. Conclusions: In this series of intermediate to high-risk patients, TAVI was associated with an excellent early and long-term survival.

Effect of pulmonary hypertension on clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation patients with valvular heart disease: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To explore the effect of pulmonary hypertension on the clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation (AF) patients with valvular heart disease. Methods    The clinical data of 84 patients who received cardiac valve replacement and Cox Maze Ⅳ ablation in our hospital from July 2017 to January 2020 were retrospectively analyzed. According to the estimation of pulmonary artery pressure (PAP) by ultrasound, the patients were divided into two groups: a group A (PAP<45 mm Hg, 20 males, 26 females with an average age of 59.1±7.8 years) and a group B (PAP≥45 mm Hg, 15 males and 23 females with an average age of 58.5±8.5 years). The PAP was less than 70 mm Hg in all patients. A systematic follow-up review was performed for 6 months after operation. The recovery and recurrence rate of sinus rhythm after surgical ablation were compared between the two groups, and the efficacy was analyzed. Results    (1) All the patients completed the operation successfully, and there was no statistical difference in the ablation time between the two groups (P>0.05); no patients died of pulmonary infection after the operation, and one patient underwent implantation of a permanent pacemaker due to conduction block. (2) At the end of the operation and 3 months after the operation, the conversion rate of AF in the group A was 91.3% (42 patients) and 82.6% (38 patients), respectively, and in the group B was 89.5% (34 patients) and 73.7% (28 patients), respectively (P>0.05). The conversion rate of AF was 82.6% (38 patients) in the group A and 63.2% (24 patients) in the group B at 6 months after operation (P=0.043). Binary logistic regression analysis showed that PAP≥45 mm Hg had a significant effect on the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease [P=0.014, OR=5.661, 95%CI (1.429, 22.432)]. Conclusion    PAP may be an influencing factor for the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease. Although the long-term recurrence rate of AF in the moderate pulmonary hypertension group is higher than that in the group A, the overall effect is still safe and effective; therefore it is still worth promoting in clinical application.

Supervivencia a los cinco años en pacientes con valvulopatías izquierdas operados de cirugía cardíaca valvular / Five-year survival of patients with left-side heart valve disease who underwent heart valve surgery

RESUMEN Introducción: La supervivencia a mediano y largo plazo es un parámetro necesario para evaluar los resultados de la cirugía valvular cardíaca. Objetivos: Determinar la supervivencia a los cinco años de los pacientes operados de cirugía cardíaca valvular aórtica, mitral o ambas, y las variables que pueden pronosticar de manera independiente una peor sobrevida en el seguimiento. Método: Se realizó un estudio de cohorte que evaluó a los 139 pacientes operados de cirugía cardíaca valvular en el trienio 2010-2012, en el Instituto de Cardiología y Cirugía Cardiovascular de La Habana, Cuba, y que fueron egresados vivos del postoperatorio, hasta un período de cinco años posteriores a la intervención. Se realizó una curva de Kaplan Meier para determinar la supervivencia al final del seguimiento, así como un análisis multivariable de Cox para determinar las variables que se asociaron a una menor supervivencia. El nivel de significación estadística empleado fue p<0,05. Resultados: La muestra resultó homogénea según las variables clínicas y demográficas. La supervivencia al término del seguimiento, que tuvo una media de 5,8 años, fue de un 93%. El incremento de la edad (HR=1,15; p=0,001) y el haber sufrido bajo gasto cardíaco durante el perioperatorio (HR=3,54; p=0,037) se asociaron de manera independiente a una peor sobrevida en el seguimiento. Conclusiones: La supervivencia de los pacientes al concluir el seguimiento fue elevada. El incremento de la edad y el bajo gasto cardíaco perioperatorio fueron las variables asociadas de manera independiente a una menor sobrevida.

ABSTRACT Introduction: The mid and long term survival rate is a necessary parameter to evaluate the outcomes of heart valve surgery. Objectives: To determine the five-year survival of patients who underwent aortic and/or mitral valve surgery, and the variables that could independently predict a lower survival in the follow-up. Method: A cohort study was conducted for evaluating 139 patients who underwent a heart valve surgery, in the period 2010-2012, at the Instituto de Cardiología y Cirugía Cardiovascular of Havana, Cuba, all of which survived the postoperative period, and were followed up to five years after the surgery. A Kaplan-Meier curve was performed to determine the survival after surgery. Also, a multivariate Cox regression was carried out to determine the variables that were independently associated with a lower survival rate. The statistical significance level used was p<0.05. Results: The sample was homogeneous according to clinical and demographic variables. The overall survival rate was 93% at the end of the study, with a mean follow up of 5.8 years. The older age (HR=1.15; p=0.001) and the history of perioperative low cardiac output syndrome (HR= 3.54; p=0.037) were the variables independently associated to lower survival in the follow-up. Conclusions: The patients' survival when concluded the follow-up was high. The older age and the perioperative low cardiac output syndrome were the variables independently associated to lower survival.

A review of heart valve disease research in Malaysia

@#Introduction: Heart valve disease comprises a cluster of conditions affecting the aortic, mitral, pulmonary and tricuspid valves. This paper reviews all the research on heart valve disease in Malaysia published between the years 2000- 2016. Methods: The methodology was based on the search process described in the paper, “Bibliography of clinical research in Malaysia: methods and brief results”. The search databases included PubMed, Scopus and several Malaysian journals such as MyJurnal and UKM Journal Repository, by using the following keywords: (heart valve disease OR infective endocarditis OR rheumatic heart disease) and (Malaysia). Results: In all 94 papers were identified of which 39 papers were selected and reviewed on the basis of their relevance. The local studies contributed to the knowledge and understanding of the epidemiology, aetiology, pathophysiology, clinical presentations, investigations, treatment, and outcomes of heart valve disease in the country. Discussion: The clinical relevance of the studies performed in the country is discussed along with recommendations for future research.

Accidente cerebrovascular embólico secundario a fibroelastoma papilar de válvula mitral / Embolic stroke secondary to a mitral valve fibroelastoma: case report

Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.

Progress of treatment criteria for tricuspid regurgitation in patients receiving left heart valve surgery / 解放军医学杂志

[Abstract] Left heart valve disease may often lead to tricuspid regurgitation. If not treated at appropriate timing, tricuspid regurgitation will be gradually aggravated to impair the function of right heart and cause right heart failure, which would exert a great impact on the prognosis and life quality of patients. As tricuspid regurgitation is affected by a variety of factors, the surgical indications of tricuspid regurgitation in patients undergoing left heart valve surgeries have not yet reached a unified specifications and standards. The authors reviewed in present paper the pathological mechanism, ultrasonic diagnosis, surgical indications and patterns of the left heart valve disease accompanied with tricuspid regurgitation for the purpose of reducing the incidence of tricuspid regurgitation and optimizing the treatment in patients undergoing left heart valve surgery.

Risk and management strategy of pregnancy after valve replacement for rheumatic heart disease / 中国实用妇科与产科杂志

Pregnancy after valve replacement for rheumatic heart disease is a high-risk pregnancy.There are risks of valve thrombosis,anticoagulation-related complications, prosthetic valve dysfunction and prosthetic valve endocarditis.Comprehensive preconception evaluation and strict management should be carried out in order to reduce maternal and neonatal complications.

Reparación de la insuficiencia tricuspídea: resultados a largo plazo en 114 pacientes / Repair of tricuspid valve insufficiency: long-term results in 114 patients

Resumen Antecedentes la reparación de la insuficiencia tricuspídea funcional está indicada en casos de insuficiencia cardíaca, generalmente, asociada a enfermedades de las válvulas cardíacas izquierdas y en algunos casos de enfermedad coronaria o cardiopatías congénitas. Objetivo : evaluar los resultados a largo plazo de la reparación tricuspídea en pacientes operados en la región centro sur de Chile. Pacientes y métodos : estudio retrospectivo de registros clínicos y operatorios en 114 pacientes con edad promedio 57.8 (DE 13) años (72 mujeres) sometidos a reparación tricuspídea asociada a otros procedimientos quirúrgicos entre 2009 y 2017. Resultados : la etiología de la insuficiencia tricuspídea fue debida a enfermedad reumática inactiva en 45% y a endocarditis infecciosa en 2.6%. 63% estaban en fibrilación auricular y 75% en capacidad funcional NYHC III. 15.8% tenían cirugía valvular cardíaca previa. El ecocardiograma mostró insuficiencia severa en 56% de los casos y había hipertensión pulmonar severa en 39.5%. La cirugía consistió en la implantación de un anillo semi-rígido en forma concomitante a reemplazo o reparación de lesión valvular mitral, reemplazo valvular aórtico, cierre de comunicación interauricular, cirugía coronaria o resección de tumor intra cardíaco. La mortalidad post operatoria global fue 16%, debido a falla multisistémica en 6%, insuficiencia cardíaca en 5% y hemorragia cerebral en 4.3%. El seguimiento promedio fue 78.8 (DS 7.2) meses. La supervivencia actuarial fue 74% a los 60 y 68% a los 96 meses. Conclusión : La cirugía de reparación de la insuficiencia tricuspídea moderada o severa, asociada a otras enfermedades cardíacas provee una buena recuperación sintomática, con excelente sobrevida alejada.

Abstract Background : Surgery for functional tricuspid valve insufficiency is indicated in cases of congestive heart failure usually associated to left heart valve diseases or as a concomitant surgery for other causes such as congenital or coronary disease. Aim : To assess and report the long-term results of tricuspid valve repair in adult patients in a regional cardiac surgery center in south Chile. Patients and Methods : Retrospective review of clinical and operative records of 114 patients aged 57.8 +/- 13 years (72 women) subjected to tricuspid reparative surgery concomitant with other cardiac procedures between 2009 to 2017. Results : In 45% of cases etiology was due to inactive rheumatic disease and 2.6% was due to endocarditis. 63% presented with atrial fibrillation and 75% were in NYHC CFIII. 15.8% had a previous cardiac valve surgery. Preoperative echocardiography showed severe tricuspid insufficiency in 56% of cases and pulmonary hypertension was severe in 39.5%. In all cases tricuspid repair was performed through the insertion of a semi rigid ring as a concomitant procedure for mitral repair/replacement in most cases, aortic valve replacement, surgical closure of an ASD, CABG surgery and the resection of cardiac tumors. Overall postoperative mortality was 16% due to multi-organic dysfunction in 6%, cardiac failure in 5% and cerebral hemorrhage in 4.3%. Mean long term follow up was 78.8+/- 7.2 months. Actuarial survival was 74% at 60 and 68% at 96 months. Conclusion: Surgical tricuspid valve repair for moderate to severe tricuspid insufficiency isolated or associated to other cardiac diseases provides a good symptomatic recovery, with an excellent long term survival.

miR-27a protects human mitral valve interstitial cell from TNF-alpha-induced inflammatory injury via up-regulation of NELL-1

MicroRNAs (miRNAs) have been reported to be associated with heart valve disease, which can be caused by inflammation. This study aimed to investigate the functional impacts of miR-27a on TNF-α-induced inflammatory injury in human mitral valve interstitial cells (hMVICs). hMVICs were subjected to 40 ng/mL TNF-α for 48 h, before which the expressions of miR-27a and NELL-1 in hMVICs were altered by stable transfection. Trypan blue staining, BrdU incorporation assay, flow cytometry detection, ELISA, and western blot assay were performed to detect cell proliferation, apoptosis, and the release of proinflammatory cytokines. We found that miR-27a was lowly expressed in response to TNF-α exposure in hMVICs. Overexpression of miR-27a rescued hMVICs from TNF-α-induced inflammatory injury, as cell viability and BrdU incorporation were increased, apoptotic cell rate was decreased, Bcl-2 was up-regulated, Bax and cleaved caspase-3/9 were down-regulated, and the release of IL-1β, IL-6, and MMP-9 were reduced. NELL-1 was positively regulated by miR-27a, and NELL-1 up-regulation exhibited protective functions during TNF-α-induced cell damage. Furthermore, miR-27a blocked JNK and Wnt/β-catenin signaling pathways, and the blockage was abolished when NELL-1 was silenced. This study demonstrated that miR-27a overexpression protected hMVICs from TNF-α-induced cell damage, which might be via up-regulation of NELL-1 and thus modulation of JNK and Wnt/β-catenin signaling pathways.

Clinical Efficacy of Surgical Radiofrequency Ablation-Modified Maze Procedure in Treating Atrial Fibrillation Patients With Large Left Atrial Heart Valve Disease / 中国循环杂志

Objective: To explore the clinical efficacy of surgical radiofrequency ablation-modified Maze procedure in treating atrial fibrillation (AF) patients with large left atrial heart valve disease. Methods: A total of 267 patients received cardiac valve replacement and radiofrequency ablation-modified Maze procedure at the same time in our hospital from 2014-01 to 2015-15 were retrospectively studied. Based on the size of left atril, patients were divided into 2 groups: Group A, patients with left atrial size<60 mm, n=182 and Group B, patients with left atrial size≥60 mm, n=85. All patients were followed-up for 6 months after operation, clinical efficacy of surgical radiofrequency ablation-modified Maze procedure in treating AF was compared between 2 groups. Results: ①All patients were successfully completed the operation, radiofrequency ablation time was similar between Group A and Group B [18-32 (24±4) min] vs [22-38 (25±6)min], P>0.05. ②The ratios for recovering to sinus rhythm at the end of operation and discharge in Group A were 156/182 (86%) and 152 (84%), in Group B were 56/85 (66%) and 54 (64%); at 3 and 6 months post-operation in Group A were 149/182 (81.6%) and 146 (80.2%), in Group B were 48/85 (56.4%) and 46 (54.1%), all P<0.05. ③No patients needed installing permanent pacemaker, no operative mortality and no ablation related complications.Conclusion: Radiofrequency ablation-modified Maze procedure was safe, simple and effective in treating heart valve disease complicated AF, the effect in patients with left atrial ≥60 mm was inferior than left atrial<60mm; it could be used in clinical practice.

Correlation Factor Analysis for Cardiac Morphology and Valvular Regurgitation in Normal Tibetan Population at High Altitude Area / 中国循环杂志

Objective: To explore the correlation factors for cardiac morphology and valvular regurgitation in normal Tibetan population at high altitude area. Methods: Based onTibetan permanent resident population, a 4-stage cluster random sampling was conducted to drawn normal Tibetan subjects. Personal information and medical history were collected; physical parameters including blood and urine tests, ECG, chest X-ray and echocardiography were examined; cardiac morphology and valvular stenosis and regurgitation were detected. Canonical correlation study and Logistic regression analysis were performed to investigate the correlation factors for cardiac structure and function. Results: A population of 4 688 in Tibetan area were involved and 1 820 normal subjects were studied including 694 from Lhasa, 575 from Naqu, 286 from Nyingchi and 265 from Shigatse area. Canonical correlation analysis revealed that in normal Tibetan population, the major relevant physiological parameters for measuring right ventricle were age, blood oxygen saturation and body weight; for left ventricle were body weight, age and height; gender had no real differences. Logistic regression analysis presented that body weight, pulse and blood oxygen saturation were negatively related to mild tricuspid regurgitation; age was positively related to mild mitral and aortic regurgitations, all P<0.01. Conclusion: Age and body weight were the correlation factors for cardiac morphology and mild valvular regurgitation in normal Tibetan population at high altitude area, which should be alert in heart disease investigation.

Pathogenesis and treatment of calcific aortic valve stenosis / 中国医师进修杂志

Aortic stenosis is a common heart valve disease.Among adults,the most crucial cause of aortic stenosis is aortic valve calcification. Recent studies have shown that several factors may efficiently lead to aortic valve calcification such as age,valve structure,metabolism and genes.Although the main treatment for aortic valve calcification is still via surgery, with the further and deeper investigation in pathomechanism of aortic stenosis,we have made progress in pharmaceutical therapy for aortic valve stenosis patients.This article mainly focuses on the pathogenesis and treatment of calcified aortic valve stenosis.

Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery / Prevalência e Predição de Doença Arterial Coronariana Obstrutiva em Pacientes Submetidos a Cirurgia Valvar Primária

Abstract Background: The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement. Objectives: To evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score. Methods: Cross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value < 0.05 was adopted as statistical significance. Results: The prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations. Conclusions: Obstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease.

Resumo Fundamento: A prevalência de doença arterial coronariana (DAC) nos pacientes valvares é semelhante à da população geral, com associação usual aos fatores de risco tradicionais. Ainda assim, a busca por DAC obstrutiva é mais agressiva nos valvulopatas em pré-operatório, determinando a angiografia coronariana invasiva (ACI) a praticamente todos os pacientes adultos, uma vez que se acredita que a cirurgia de revascularização miocárdica deva ser associada à troca valvar. Objetivos: Avaliar a prevalência de DAC obstrutiva e identificar fatores a ela associados em adultos candidatos à cirurgia cardíaca primariamente valvar entre os anos de 2001 a 2014 no Instituto Nacional de Cardiologia (INC) e elaborar um modelo preditivo de DAC obstrutiva através de escore derivado de análise multivariada. A partir da estimativa da probabilidade pré-teste de DAC obstrutiva, espera-se melhor estratégia pré-operatória para cada paciente. Métodos: Estudo transversal avaliando 2.898 pacientes com indicação de cirurgia cardíaca por qualquer etiologia. Desses, foram estudados 712 pacientes valvopatas submetidos à ACI nos 12 meses anteriores à cirurgia. Diferenças com valor de p < 0,05 foram consideradas estatisticamente significativas. Resultados: A prevalência de DAC obstrutiva foi de 20%. Um modelo preditivo de DAC obstrutiva foi criado a partir de regressão logística multivariada, utilizando as variáveis idade, dor torácica, história familiar de DAC, hipertensão arterial sistêmica, diabetes mellitus, dislipidemia, tabagismo e sexo masculino. O modelo demonstrou excelente correlação e calibração (R2 = 0,98), além de ótima acurácia (ROC de 0,848; IC95% 0,817 - 0,879) e validação em diferente população valvar (ROC de 0,877; IC 95%: 0,830 - 0,923). Conclusões: É possível estimar DAC obstrutiva a partir de dados clínicos com elevada acurácia, o que pode vir a permitir estabelecer estratégias pré-operatórias de acordo com a probabilidade pré-teste individual, evitando a indicação indiscriminada de procedimentos desnecessários e invasivos, principalmente nos grupos de menor probabilidade de DAC obstrutiva. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Comparison of the Outcomes between Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in Patients Aged above 80

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been suggested as a less invasive treatment for high-risk patients with aortic valve disease. In this study, we compared the outcomes of conventional surgical aortic valve replacement (AVR) and TAVR in elderly patients aged over 80. METHODS: A total of 108 patients aged 80 years or older who underwent isolated AVR (n=35) or TAVR (n=73) from 2010 through 2015 at Asan Medical Center were identified. Early and late clinical outcomes, including echocardiographic findings, were evaluated in both groups. The mean follow-up duration was 766.4±528.7 days in the AVR group and 755.2±546.6 days in the TAVR group, and the average timing of the last follow-up echocardiography was at 492.6±512.5 days in the AVR group and 515.7±526.8 days in the TAVR group. RESULTS: The overall early mortality was 2.8% (0 of 35, 0% in the AVR group vs. 3 of 73, 4.1% in the TAVR group). Permanent pacemaker insertion was significantly more common in the TAVR group (p=0.010). Renal failure requiring dialysis and new-onset atrial fibrillation was more frequent and the length of hospital stay was longer in the AVR group; however, this difference did not reach statistical significance. In the TAVR group, 14 patients (19.2%) were rehospitalized due to cardiac problems, and 13 patients (17.8%) had developed significant paravalvular leakage by the time of the last follow-up echocardiography. CONCLUSION: TAVR could be a good alternative to conventional surgical AVR in elderly patients. However, TAVR has several shortcomings, such as frequent significant paravalvular leakage or readmission, which should be considered in decision-making.

Treatment of Atrial Fibrillation in Elderly Patients with the Cox Maze Procedure Concurrently with Other Cardiac Operations

BACKGROUND: In elderly patients who have atrial fibrillation (AF), surgical ablation of the arrhythmia during cardiac surgery may be challenging. Despite the reported advantages of ablating AF with the Cox maze procedure (CMP), the addition of the CMP may complicate other cardiac operations. We evaluated the effect of the CMP in elderly patients concurrent with other cardiac operations. METHODS: From October 2007 to December 2015, we enrolled 27 patients aged >70 years who had AF and who underwent the CMP concurrently with other cardiac operations. The mean preoperative additive European System for Cardiac Operative Risk Evaluation score was 8±11 (high risk). RESULTS: Only 1 hospital death occurred (4%). The Kaplan-Meier method showed a high 5-year cumulative survival rate (92%). At mean follow-up of 51 months, 23 patients (89%) had sinus rhythm conversion. The postoperative left atrial dimensions did not significantly differ between the 8 patients who had reduction plasty for giant left atrium (53.4±7.5 cm) and the 19 patients who did not have reduction plasty (48.7±5.7 cm). CONCLUSION: In patients aged >70 years, concurrent CMP may be associated with a high rate of sinus rhythm conversion without increased surgical risk, despite the added complexity of the main cardiac procedure.

Cardiac papillary fibroelastoma; when, how, why.

We would like to present an interesting case operated on in our department and discuss the international bibliography about this issue. We also present some interesting images of this case. Our material is composed from a 68‑year‑old woman treated by the authors. She presented with a small murmur in the auscultation while she was asymptomatic and then she diagnosed with a tumor on of the left coronary cusp of the aortic valve with the characteristics of papillary fibroelastoma. On the basis of the potential embolic risk either of the mass itself or of associated thrombus and the possibility of further enlargement, the patient although asymptomatic at the time of diagnosis was referred for elective surgical excision of the mass. She underwent on median sternotomy and through extracorporeal circulation the mass has been excised with the preservation of the well‑functioning valve. Through this case, we would like to discuss the bibliography for the decision making in these cases. Hence, the aim of our study is that we have to keep in mind that this kind of friable mass may be the cause of embolism, stroke or coronary artery occlusion and must be excided in a conservative setting, sparing the aortic valve.

Analysis of the clinical effect of ischemic heart valve disease combined coronary heart disease with surgical operation in the same period / 中国综合临床

Objective To study the clinical effect of ischemic heart valve disease combined coronary heart disease with surgical operation in the same period?Methods The clinical data of 31 cases patients of ischemic heart valve disease combined with coronary heart disease in Xinjiang Uygur Autonomous Region People′s Hospital from July 2013 to January 2015 were retrospective analyzed?According to the degree of cardiac function and symptoms,the patients toke the coronary artery bypass grafting treatment,combined with the actual operation of mitral valve replacement, mitral valve replacement, aortic valve replacement, double valve replacement at the same time?Postoperative follow?up for half year,the cardiac function of patients before and after operation were analyzed, the incidence of postoperative complications after the operation were record?Results All patients were treated by coronary artery bypass grafting, combined with the mitral valve replacement,mitral valve replacement, aortic valve replacement, double valve replacement for treatment during this period, the operations were success?There was statistically significant difference about cardiac functional grading before and after surgery ( P=0?000 )?There were 7 cases patients' left ventricular ejection ejection fraction( LVEF) was more than or equal to 40% of patients,24 cases patients'LVEF<40% before operation;21 cases patients'LVEF was more than or equal to 40%,8 cases patients'LVEF<40% after operation,the difference was statistical significance before and after the operation( P=0?000)?Only 2 patients were died because of low cardiac blood?Conclusion Non ischemic heart valve disease combined with coronary heart disease patients to take simultaneous surgical treatment, the difficulty of its operation has increased, but to strengthen myocardial protection during surgery can effectively enhance the clinical curative effect, reduce mortality, provide good protection for the survival of patients with late life.

Clinical observation of coronary artery bypass grafts in the same period of heart valve replacement on the treatment of coronary heart disease with heart valve disease / 实用医学杂志

Objective To analyze and discuss the value and significance of coronary artery bypass grafts in the same period of heart valve replacement in the process of the coronary heart disease with heart valve disease treatment, in order to improve the effect of treatment and reduce the incidence of adverse events. Methods 60 cases with coronary heart disease with heart valve disease , which admitted in our hospital during February 2013-February 2015, were selected as the research objectaccording to random number table method and divided into the-experimental group and the control group , each group of 30 cases according to the principle of double blind control. The experimental group was given the coronary artery bypass grafts in the same period of heart valve replacement and the control group was given the coronary artery bypass grafts without heart valve replacement. The curative ef-fects of different schemes and effects on cardiac function after surgery of the two groups were compared. Results After statistical analysis found thatthe observation indexes of the control group was significantly increased compared with the experimental group, the difference was significant statistically significant (P<0.05). The postoperativecar-diac function indexes of the experimental group was significantly improved then control group , the difference was significant statistically significant (P<0.05). Conclusion Coronary heart disease with heart valve disease in the process of treatment can also take heart valve surgery combined coronary artery bypass surgery. By preoperative and postoperative symptomatic treatment, intraoperative protect myocardium, can effectively prevent and reduce the op-eration of various complications, which is worthy of clinical popularization and application.

Risk factors analysis for patients aged over 65 years undergoing combined heart valve surgery and coronary artery bypass grafting / 中华胸心血管外科杂志

Objective To analyze the risk factors for in-hospital mortality in patients aged over 65 years undergoing heart valve surgery combined with coronary artery bypass grafting(CABG).Methods Between February 2002 and September 2014,540 patients aged over 65 years undergoing heart valve surgery combined with CABG in our institute were retrospectively studied.Univariate analyses and multivariate logistic regression analyses were performed to explore risk factors associated with in-hospital mortality.Results Overall in-hospital mortality was 4.26％.Univariate analysis depicted that chronic obstructive pulmonary disease (COPD) (P =0.001),last serum creatinine (P =0.043),unstable angina(P =0.046),Canadian Cardiovascular Society 111-ⅣV (P =0.005),number of diseased coronary vessels (P =0.043),cardiopulmonary bypass time-delayed (P =0.003),post-operative morbidity (P =0.000) had a significant impact on in-hospital mortality.Multivariate logistic regression analysis revealed that COPD (P =0.005,OR =5.598),CPB time-delayed (P ＜ 0.001,OR =1.011),re-exploration (P ＜0.001,OR =15.813),malignant arrhythmia (P =0.014,OR =4.900) were independent risk factors of in-hospital mortality.Conclusion The present research demonstrates that COPD,CPB time-delayed,re-exploration and malignant arrhythmia dramatically impacted the in-hospital mortality of patients aged over 65 years undergoing combined heart valve surgery and CABG.