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Objective:To summarize the early results and follow-up of mitral valve repair for rheumatic heart disease(RHD).Methods:From January 2018 to November 2019, 48 patients with rheumatic heart disease undergoing mitral valve repair in Cardiovascular Surgery Department of GaoZhou People' s Hospital were analyzed retrospectively. Surgical methods: according to the condition of mitral valve disease, the prosthetic mitral annulus was used in rheumatic mitral valve repair by the methods of joint incision, valve thinning, calcification stripping, Chordae tendineae release and papillary muscle splitting. All patients with tricuspid regurgitation were fixed with artificial valve ring(type C ring), and with atrial fibrillation were treated with Maze-IV radiofrequency ablation. Data on extracorporeal circulation time, aortic occlusion time, mechanical ventilation time, ICU stay time, and major postoperative complications were collected. Patients were followed up to assess mitral valve, cardiac function, and cardiac rhythm.Results:According to pathological classification, type Ⅰ were 9 cases, 31 cases as type Ⅱ and 8 cases as type Ⅲ. All patients in type I and type II were repaired successfully, and type III has 1 case who was repaired failed and underwent mitral valve replacement due to moderate regurgitation. Cardiopulmonary bypass(CPB) time was(110.62±27.68) min, Cross-clamp time was(76.63±17.63) min, ICU stay was(46.16±11.37) h, mechanical ventilation was(21.60±10.89) h. All survived at 30 days, 1 case of acute renal failure, 1 case of low cardiac output syndrome, 3 cases of pulmonary infection, no complications such as stroke and malignant Arrhythmia. 47 patients were followed up for(9.86±6.78) months. There were no death, malignant Arrhythmia and reoperation during the follow-up, and the cardiac function was improved significantly( P<0.001). Conclusion:The mitral valve repair of RHD can preserve the intact mitral valve structure, maintain the heart function, and have a good survival and quality of life. On the basis of mastering the repair of heart valve, being familiar with the anatomic features of rheumatic mitral valve disease, strictly grasping the indications, fully evaluating before operation, it is feasible to carry out the repair of rheumatic mitral valve, and the early clinical effect is satisfactory, long-term results recommend long-term follow-up.
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Objective To compare the difference between transthoracic device closure of ventricular sep-tal defect and conventional thoracotomy and examine the effect and safety of transesophageal echocardiography (TEE) guided minimally invasive transthoracic device closure of ventricular septal defect. Methods Three hun-dred and sixty-eight patients underwent isolated ventricular septal defect surgery in our hospital from May 2014 to May 2016. There were 40 patients in group A underwent TEE guided minimally invasive transthoracic device clo-sure of ventricular septal defect and 328 patients in group B underwent conventional thoracotomy surgery.By using the method of propensity score matching,we selected 40 conventional thoracotomy patients as a control group in our study. Results All patients were survived after surgery without death and other serious complications. Compared with conventional thoracotomy surgery,patient with transthoracic device closure of ventricular septal defect had sta-tistical improvement in surgery time(1.97 ± 0.48 vs. 3.55 ± 1.95)h, ICU stayed time(21.15 ± 30.52 vs. 38.37 ± 10.91)h,volume of thoracic drainag(28.39 ± 32.67 vs.174.84 ± 85.36)mL,surgery incision length(2.98 ± 0.72 vs. 11.76 ± 2.89)cm.There were no significant differences in postoperative valvular regurgitation,arrhythmia and resid-ual shunt between the two groups.Conclusion TEE guided minimally invasive transthoracic device closure of ven-tricular septal defect is safe,effective,feasible,less trauma,less bleeding,faster recovery and etc.