Causes and treatment strategies of unilateral leaflet escape of bileaflet mechanical prosthetic heart valves after surgery: a case series.

BACKGROUND: During the eleven years from 2010 to 2021, preliminary statistics have shown that Fuwai Hospital completed 23,571 mechanical valve replacements for various types of valves, and 1139 mechanical valve replacements were performed in Guangyuan First People's Hospital. Only two patients developed valve leaflet escape, so valve leaflet escape is a rare postoperative complication. CASE PRESENTATION: In 2010 and 2021, two patients were selected after they had unilateral leaflet escape after having mechanical valve replacements in Fuwai Hospital of Chinese Academy of Medical Sciences and Guangyuan First People's Hospital. Both patients underwent reoperations with the classic operation and the new bileaflet mechanical prosthetic heart valve was sutured. The treatment of detached single lobe and distal vessel was comprehensively determined, and the condition was treated according to the patient's symptoms, CT results, ultrasound results and other test results, as well as whether this detached lobe caused any abnormal hemodynamics of the distal vessel. The patient with mechanical aortic valve escape completed the 10-year follow-up, and patient with mechanical mitral valve escape completed the 3-month follow-up. there was no thrombosis or hematoma at the embolic site; the patient had no lower limb symptoms. CONCLUSIONS: The reason for the leaflet escape may be related to the valve design and the leaflet material. If the detached leaflets are damaged and if the distal blood vessels are affected, simultaneous surgical treatment is required. Those patients whose vessels were not damaged by the valve lobe should be carefully monitored.

Effect of 3D-printed hearts used in left ventricular outflow tract obstruction: a multicenter study.

OBJECTIVE: The purpose of this research was to explore the application value of a three-dimensional (3D)-printed heart in surgery for left ventricular outflow tract (LVOT) obstruction. METHODS: From August 2019 to October 2021, 46 patients with LVOT obstruction underwent surgical treatment at our institution. According to the treatment method, 22 and 24 patients were allocated to the experimental and control groups, respectively. In the experimental group, each patient's 3D-printed heart model was used for simulated preoperative surgery, and then the Morrow operation was performed. In the control group, only the Morrow operation was performed, without simulated preoperative surgery using a 3D-printed heart model. The intraoperative and postoperative data of patients in the two groups were recorded, and the clinical data of patients were compared between the two groups. RESULTS: The operation time, cardiopulmonary bypass time, intraoperative blood loss, hospitalization time, LVOT pressure difference (LVP), postoperative interventricular septal thickness (IST), aortic regurgitation (AR), systolic anterior motion (SAM), and postoperative left ventricular flow velocity (LVFV) were significantly lower in the experimental group than in the control group (P < 0.05). The inner diameter of the left ventricular outflow tract (IDLV) was larger in the experimental group than in the control group (P < 0.05). There was no significant difference in the postoperative ejection fraction, atrioventricular block rate or complication rate between the two groups (P > 0.05). CONCLUSION: A 3D-printed heart model for simulated surgery in vitro is conducive to formulating a more reasonable surgical plan and reducing the trauma and duration of surgery, thereby promoting the recovery and maintenance of the heart.

Cardiopulmonary haemodynamics after sieve-shaped atrial septal defect repair: a multicenter study.

OBJECTIVE: The study aimed to collect case data on cardiopulmonary bypass (CPB) sieve-shaped (S-S) and non-sieve-shaped (N-S-S) atrial septal defects (ASDs). METHODS: We analysed and summarized the postoperative blood flow in the cardiopulmonary system. We retrospectively collected 86 patients who underwent CPB S-S and N-S-S ASD repair. The data collected included sex, age, CPB time, ASD area, percentage change in ventricular value (PVV) (preoperative/postoperative), left ventricular wall thickness, ejection fraction (EF) (preoperative/postoperative), fluid inflow value, pulmonary arterial pressure/pulmonary venous pressure, percentage change in total lung resistance (PTLR) (preoperative/postoperative) for statistical analysis and comparison. RESULTS: There were 86 eligible patients in this study, 37 and 49 of whom had S-S and N-S-S ASDs, respectively. The PVV, PTLR, and pulmonary arterial pressure/pulmonary venous pressure (postoperative) were significantly different between the S-S and N-S-S groups. The mean PTLR in the S-S and N-S-S groups was 0.78±0.24 and 0.62±0.28, respectively. The mean PVV in the S-S group was 11.53±7.63, and that in the N-S-S group was 16.47±9.71. Multivariate analysis revealed PVV (OR, 0.143; 95% CI, 0.026-0.790; P=0.026), PTLR (OR, 0.156; 95% CI, 0.049-0.500; P=0.002), and pulmonary arterial pressure/pulmonary venous pressure (postoperative) (OR, 9.014; 95% CI, 2.480-32.755; P=0.001) as significant factors. The rate of pulmonary infection absence postoperatively in the S-S group was 76.52%, and that in the N-S-S group was 42.75%. CONCLUSION: Due to the differences in heart structure between the S-S and N-S-S groups, the haemodynamic index (PVV and PTLR, postoperative pulmonary arterial pressure/pulmonary venous pressure) changes after S-S ASD repair were less than those after N-S-S ASD repair, so the postoperative pulmonary infection rate was higher after N-S-S ASD repair. The pulmonary infection rate was low after S-S ASD repair, and drugs should be reasonably administered to prevent infection.