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Objective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.
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A 35-year-old man was referred to our hospital for surgical repair of grade IV/IV aortic regurgitation secondary to a congenital unicuspid aortic valve accompanied by aneurysm of the ascending aorta. The aortic valve was the unicuspid unicommissural type and a fully developed commissure was located in the left lateral position (left coronary/right coronary). The anterior (non-coronary/right coronary) and posterior (non-coronary/left coronary) borders were rudimentary with calcified raphe. We performed aortic valve repair in combination with valve sparing root replacement (reimplantation) and partial arch replacement. We converted the unicuspid into a bicuspid aortic valve by preserving his own free margin tissue and creating a neocommissure to the 180 degrees opposite side of the left lateral commissure at the same height by enlarging the cusp with a glutaraldehyde-treated autologous pericardium patch to the cusp belly. The patient was discharged on the 17th postoperative day with trace aortic regurgitation. We successfully repaired the unicuspid aortic valve by augmenting the cusp size using a pericardium patch in order to preserve the free margin of the cusp.
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Objective To compare the mid-term outcomes of valved bovine jugular vein conduit and autologous pericardium conduit in reconstruction of right ventricular outflow tract. Methods Eighteen congenital heart disease patients were implanted with external conduits (included 11 valved bovine jugular vein conduits and 7 autologous pericardium conduits) for right ventricular outflow tract reconstruction between May 2013 and Jul. 2016. There were 11 males and 7 females at age of 2-16 (5.22±4.12) years. Preoperative clinical diagnoses included pulmonary artery atresia with ventricular septal defect (n＝7), double outlet of right ventricle with pulmonary stenosis (n＝4), persistent truncus arteriosus (n＝3), persistent truncus arteriosus with absence of right pulmonary artery (n＝1), corrected transposition of great arteries with pulmonary stenosis (n＝1), and transposition of great arteries with pulmonary stenosis (n＝2). The perioperative status was recorded. The cardiac ultrasound and computed tomography angiography (CTA) were used to evaluate the efficacy during 4-56 months of follow-up. Results There were no perioperative deaths in the bovine jugular vein conduit group, and 2 deaths in the autologous pericardium conduit group. One died of pulmonary hypertension crisis and the other died of low cardiac output syndrome. The ratio of right ventricular pressure to radial arterial pressure, duration of mechanical ventilation and intensive care unit (ICU) stay after surgery were significantly lower in the bovine jugular vein conduit group than those in the autologous pericardium conduit group (all P0.05). There were no significant differences in extracorporeal circulation time, aortic cross-clamping time, transvalvular gradient in right ventricular outflow tract, blood consumption or total hospitalization costs between the two groups (all P0.05). During follow-up, there were no deaths in the two groups, no reoperations in the bovine jugular vein conduit group, and 1 case received reoperation 2 years after surgery due to severe right ventricular dysfunction in the autologous pericardium conduit group. In the bovine jugular vein conduit group, the transvalvular gradients in right ventricular outflow tract at the last follow-up and before discharge were (22.91±7.31) mmHg (1 mmHg＝0.133 kPa) and (20.45±6.70) mmHg, respectively, and the difference was not significant (P0.05). In the autologous pericardium conduit group, the transvalvular gradient in right ventricular outflow tract was (29.20±18.09) mmHg at the last follow-up and (16.14±4.02) mmHg before discharge, and the difference was significant (P0.05). At the last follow-up after surgery, there were 8 cases of mild reflux and 3 cases of moderate reflux in the bovine jugular vein conduit group, and 1 case of mild reflux, 2 cases of moderate reflux and 2 cases of severe reflux in the autologous pericardium conduit group, and the difference between the two groups was significant (P0.05). Postoperative ultrasonography showed the thickened valve leaflets with good valve movement in the bovine jugular vein conduit. No calcification, thrombosis and infective endocarditis were found in the two groups. Postoperative cardiac CTA found that there was aneurysmal dilatation in 1 middle segment and 1 proximal anastomotic stoma of the bovine jugular vein conduit group, and no dilatation in the autologous pericardium conduit group. Conclusion Domestic valved bovine jugular vein conduit is suitable for right ventricular outflow tract reconstruction in patients with complex congenital heart malformations. Mid-term follow-up shows that bovine jugular vein conduit has good anti-reflux performance and no severe obstruction or calcification. It is obviously superior to autologous pericardium conduit. However, some bovine jugular vein conduits have aneurysmal dilatation in mid-term follow-up, which needs to be further improved.
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Right sided infective endocarditis (RSIE) is uncommon. Patients are traditionally treated with antibiotics alone, and indications for operation are not clearly established. A 23-years-old man who developed fever and general fatigue was referred to our hospital on the suspicion of RSIE. A ventricular septal defect (VSD) and untreated dental caries had been previously diagnosed. Transthoracic echocardiography revealed vegetation on the tricuspid valve and severe regurgitation. The tricuspid valve was repaired ; the anterosuperior leaflet was partially resected and repaired with fresh autologous pericardium and the use of synthetic chordae. Recurrence of infection and tricuspid valve regurgitation were not observed for 1 year after this operation.
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Objective To conclude the preliminary results of aortic valve repair with autopericardium.Methods After routine median sternotomy the pericardium was isolated and immersed into the 0.6% glutaraldehyde immersion for 10 minutes, then rinsed off before use.Conventional extracorporeal circulation was established and diseased aortic valves were removed.The curves lengths between three commissures measured with the specific sizers.The corresponding size of the pericardial patchs was used to cut the new aortic leaflets.The continuous Johnson Prolene 4-0 sutures were used to fixed the new aortic valve leaflets to the anulus.Another new 4-0 prolene suture were used to fix the new three commissures outside the aortic wall with mat.The new mat stripes were used to fix the sinus in condition with the aortic sinus dilation or bileaflets malformation.Results Since 2015 October total 27 patients received aortic valve repair with autologous pericardium.The age was in the range of 27 to 60 years old including 18 female and 9 male.There were 7 cases diagnosed as aortic valve stenosis and 20 cases aortic insufficiency.And there were 3 cases bileaflets aortic valve deformity.The mean bypass time is(104±25)mins.Postoperative esophageal ultrasound showed good coaptation of the aortic valve without significant regurgitation.The mean transvalve gradient was(8.5±3.2)mmHg(1 mmHg=0.133 kPa).In the early stage one case diagnosed with aortic valve stenosis and regurgitation received monocusp repaired with autologous pericardial leave.But there was still moderate aortic regurgitation and had to receive the aortic valve replacement.All patients recovered well and were treated with Aspirin for 6 months.The followed up lasted for 3 to 13 months.Mean aortic occlusion time was(104±25) minutes.The patients were followed up for 3-13 months, the cardiac function and aortic valve function were stable, and no gradient increased.Conclusion It is relatively simple to perform the aortic valve repair with individual autologous pericardial sizer technique and the primary clinic results are satisfactory.It is worthy of further study and long-term follow-up.
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<p>A 46-year-old man who developed fever and general fatigue was referred to our hospital with suspicion of infective endocarditis. A ventricular septal defect had been previously diagnosed. Transthoracic echocardiography revealed vegetation on the aortic, mitral, and pulmonary valves, and each valve had significant regurgitation. An emergency operation was performed because of congestive heart failure. The aortic and mitral valves were replaced with mechanical valves. The pulmonary valve was repaired ; the anterior leaflet was resected and replaced by glutaraldehyde-treated autologous pericardium. The patient's postoperative course was uneventful. Recurrence of infection was not observed for 3 years after the operation. Triple-valve endocarditis, especially that involving a combination of the aortic, mitral, and pulmonary valves, is rare. Involvement of multiple valves on both sides of the heart may be attributed to a congenital intracardiac shunt. Early surgical intervention may be useful to control infection and heart failure, as in the present case.</p>
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<p>An 82-year-old man was referred to our hospital for heart failure due to severe mitral regurgitation and severe tricuspid regurgitation. We performed mitral annuloplasty and tricuspid annuloplasty (TAP). Three weeks after surgery, he developed hemolytic anemia (HA). Transesophageal echocardiography revealed a defect in the left ventricular outflow tract that communicated directly with right atrium, and the jet was striking with the TAP prosthetic ring. HA was not controlled, so we performed re-operation. The defect was found in the atrioventricular membranous septum. The defect was closed and TAP was performed using an autologous pericardial roll again. We report a rare case of acquired left ventricular to right atrium communication after TAP.</p>
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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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Objective To evaluate the clinic effect of leaflet enlargement with autologous pericardium in repairing mitral valve disease and to describe the technique and discuss its indications. Methods Between July 2004 and June 2008, 45 pa-tients with isolated mitral valve disease, included stenosis in 10 and regurgitation in 35. The causes were congenital heart dis-ease in 8, rheumatic in 21, degenerative in 7 and endecarditis in 9. The procedures were: posterior leaflet enlargement with autologuus pericardium in 14, anterior leaflet enlargement in 8, both anterior and posterior leaflet enlargement in 23. In addi-tion, eye to eye technique was in 12, artificial chordal in 12, chordal transfer in 6, papillary muscle vepesitioning in 4. Mitral anuuloplasty was performed in all cases. Before and after surgery, cardiac function parameters were compared. Results No operative deaths occurred. One case wastransfered to mitral valve replacement due to regurgation, lntraoperative transesophageal echocardiography showed no mitral regurgitation in 38 and small regurgitation in 6 cases. The mean mitral valve effective orifice area(MVEOA) was (2.8±0.6) cm~2, with a mean gradient pressure of (6.21±1.34) mm Hg after operation. The mean followed up was ( 18.0±2.1 ) months. Echocardiography study showed that no mitral regurgitation in 35 cases, slight regurgi-tation in 9, mean mitral effective orifice area was (2.5±0. 8 ) cm~2, mean gradient pressure of (7.21±0. 45 ) mm Hg, no one need reoperation. Postoperative cardiac functions were significantly improved: the average left ventricular end-diastolic diameter (LVEDD) was (48±7) mm [ preoperative (56±6) nun, P <0.05], ejection fraction (EF) was 0.51～0.24( preoperative 0.45± 0.23, P < 0.05 ), the average left atrium diameter ( LA ) was ( 50±11 ) mm [ preoperative ( 62±23 ) mm, P <0. 05 ]. The function of mitral valves was well performed. Conclusion Leaflet enlargement with autologous pericardium com-bined with mitral annuloplasty was effective in repairing of diseased mitral valve. The advantages of the procedure including simplicity, good compatibility, avoiding foreign body and no need for anticoagulation.