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@#Objective To summarize the early outcomes of totally thoracoscopic minimally invasive aortic valve replacement (AVR) and double valve replacement (DVR). Methods The clinical data of patients who underwent totally thoracoscopic minimally invasive AVR or DVR in Guangdong Provincial People’s Hospital from April 2020 to January 2021 were retrospectively analyzed. The patients were divided into an AVR group and a DVR group according to the surgical method, and the clinical data of the two groups were compared. Results Finally 22 patients were enrolled, including 14 males and 8 females with an average age of 50.0±11.2 years at operation. Eight patients were degenerative disease, 8 were rheumatic heart disease combined with valvular disease, and 6 were bicuspid aortic valve. Out of the 22 patients, 16 underwent AVR alone, and 6 underwent DVR. All patients completed the operation successfully, and there was no death. Perivalvular leakage during surgery occurred in 2 patients. The average cardiopulmonary bypass time was 187.0±39.9 minutes, and aortic cross-clamping time was 117.0 (99.0, 158.0) minutes. Duration of mechanical ventilation and intensive care unit stay was 9.5 (4.8, 18.3) hours and 41.0 (34.0, 64.0) hours, respectively. The volume of chest drainage at the first 24 hours after surgery was 214.0±124.6 mL, and the postoperative hospital stay was 5.5 (4.0, 8.3) days. The cardiopulmonary bypass time and aortic cross-clamping time in the DVR group were longer than those in the AVR group, and the volume of chest drainage at 24 hours after surgery was more than that in the AVR group, with a statistical difference (P<0.05). Echocardiography before hospital discharge showed paravalvular leakage in 1 patient. There was no death during follow-up of 5.9±3.0 months. Conclusion The early outcome of totally thoracoscopic minimally invasive AVR and DVR is satisfactory, and the approach of surgery is worth exploring.
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@#Thoracoscopic minimally invasive technology has been used in mitral valve plasty since 1990s. Totally thoracoscopic mitral valve plasty has the advantages of small trauma, beautiful incision and rapid postoperative recovery. It is favored by more and more patients and cardiac surgeons. However, according to the reports, the proportion of totally thoracoscopic mitral valve surgery in China is still low. Mitral valve plasty via the totally thoracoscopic approach is still controversial in terms of population adaptation, perioperative complications and long-term prognosis. In addition, the technical difficulty and the long training cycle of surgeons also limit the popularization of this technology. By summarizing the existing literature, this paper analyzes the application and development of totally thoracoscopic approach in comparison with the traditional median thoracotomy mitral valve plasty.
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@#Objective To investigate the predictive value of right atrial myocardial fibrosis in the prognosis of isolated tricuspid regurgitation surgery after left heart valve surgery. Methods The patients who underwent tricuspid valvuloplasty by the same operator in Guangdong Provincial People's Hospital from April 2016 to August 2021 due to long-term isolated severe tricuspid regurgitation after left heart valve surgery were included in the study. According to the degree of right atrial myocardial fibrosis, the patients were divided into three groups: a mild group, a moderate group, and a severe group. The clinical data of these patients were compared and analyzed. Results A total of 75 patients were enrolled, including 16 males and 59 females with an average age of 57.0±8.4 years. There were 30 patients in the mild group, 29 patients in the moderate group and 16 patients in the severe group. In terms of the preoperative data, there were statistical differences in cardiac function grade, right atrial diameter, tricuspid incompetence area among the three groups (P<0.05). In terms of the postoperative data, there were statistical differences among the three groups in the cardiopulmonary bypass time, mechanical ventilation time, ICU monitoring time, complication rate and mortality (P<0.05). Further pairwise comparison showed that, compared with the mild group, the severe group had longer mechanical ventilation time (P=0.024), longer ICU monitoring time (P=0.003) and higher incidence of postoperative complications (P=0.024), while the moderate group had no statistical difference in all aspects (P>0.05); compared with the moderate group, the severe group had longer ICU monitoring time (P=0.021) and higher incidence of complications (P=0.006). Conclusion The early outcome of tricuspid valvuloplasty in patients with isolated tricuspid regurgitation after left heart valve surgery with severe right atrial myocardial fibrosis is worse than that in the patients with mild and moderate fibrosis, suggesting that the degree of myocardial fibrosis in the right atrium can be a predictor of the effect of tricuspid regurgitation surgery and a judgement indicator of the surgery timing.
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Objective To investigate the feasibility of magnetic resonance diffusion-weighted intravoxel incoherent motion (DW-IVIM)imaging and its reproducibility in normal liver.Methods Thirty-five young healthy volunteers underwent liver DW-IVIM ex-amination twice on a 1 .5 Tesla Philips MR scanner.Parameter maps of D,D* and f were generated by using a manufacturer-sup-plied software.Six Region-of-interests (ROIs)(3 ROIs in left and right liver lobe,respectively)were drawn on three consecutive middle slices,respectively.The average values of D,D* and f were measured and compared between the left and right liver lobe. The reproducibility of D,D* and f measurement were assessed with Bland-Altman method.Results The values of D,D* and f of left liver lobe [D(×10-3 mm2/s):1.250±0.210,D*(×10-3 mm2/s):101.906±15.063 ,f(%):22.954±5.268]were statistically higher than those of right liver lobe[D(×10-3 mm2/s):1.039±0.124,D*(×10-3 mm2/s):100.127±20.757,f(%),18.317± 3.671](D,f,P<0.001,D*,P<0.232-0.605),however ,their reproducibility of left liver lobe [limit of agreement(LOA):22.55%,51.05%,39.3%,respectively]were lower than those of right liver lobe (LOA:20.3%,39.25%,33.9%).The D values had the best reproducibility in both the left and right liver lobe.Conclusion The liver DW-IVIM is feasible.The values of D,D*and f in left liver lobe were higher that those in right liver lobe but with worse reproducibility of measurement.The D value was most reproducible in both liver lobes.
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Purpose To investigate the effect of two different 1.5T MRI scanners on the apparent diffusion coefficient (ADC) measurement and its reproducibility in diffusion weighted imaging (DWI) of the liver. Materials and Methods Two groups of volunteers (33 people in each group) underwent liver DWI examination twice by using the same DWI sequence with b value of 0 and 800 s/mm2 on different MRI scanners (1.5T Siemens Espree and 1.5T Philips Achieva). On ADC maps, two region of interests were placed on three central slices of the left and right liver lobes, respectively. The ADC measurements of six region of interests on left and right liver lobes were averaged to represent the mean ADC values of the left and right liver lobe, respectively. The reproducibility of the ADC measurements was assessed by Bland-Altman method. Results The ADC values of the left and right liver lobes measured on Siemens MRI scanner were significantly higher than those on Philips MRI scanner (t=2.045-2.713, P<0.05); on both scanners, the ADC values of the left liver lobe were significantly higher than those of the right liver lobe (t=-10.561--7.263, P<0.001). The Bland-Altman results showed that the reproducibility of ADC measurement was similar on both MRI scanners, and both displayed higher reproducibility of right liver lobe than that of left liver lobe (on Siemens MRI scanner: the agreement were 16.65% and 7.55% for the left and right liver lobe, respectively;and on Philips MRI scanner:16.30%and 7.85%, respectively. Conclusion Different MRI scanners may have influence on ADC values, but does not affect its reproducibility. Therefore, when ADC values obtained on different MR scanners are compared in clinical analysis, this influence should be considered.