Preoperative evaluation is crucial for heart valvular surgery. This article discusses some issues that need to be emphasized: the impact of hypertension on the severity of aortic valve lesions, and how to improve the accuracy of clinical assessment; the identification of functional tricuspid regurgitation, in order to choose the appropriate surgical technique; the need for right ventricular function testing, and the use of risk scoring models, to better grasp surgical timing and indications and improve efficacy; and the importance of evaluating atrial mitral and/or tricuspid regurgitation complications in chronic atrial fibrillation, and making rational choices for interventional and surgical treatment.
Early enteral nutrition after cardiopulmonary bypass (CPB) has been shown to have beneficial effects on intestinal integrity, lower mortality and also on the patient’s immunocompetence. Even in critical patients after CPB, enteral nutrition should be reasonable to start early and also be supplemented by parenteral nutrition in order to meet energy requirement. We conclude that enteral nutrition is preferable in the majority of patients with severe hemodynamic failure, but gastrointestinal complication and hypocaloric feeding should be simultaneously noticed. This paper comprehensively described enteral nutrition’s protective mechanism and effects on digestive system, enteral nutrition’s implementing methods after CPB, and problems or prospects needing attention in execution.
Abstract： Quality of life （QOL） refers to an individual’s perception and subjective evaluation of their health and well-being, and has become an important index to evaluate the outcomes of clinical treatment in the last past decades. There are a large number of different instruments to evaluate QOL, and the 36-Item Short Form Health Survey （SF-36） is currently one of the most widely used instruments. In recent years, SF-36 has been used to evaluate QOL of valvular heart disease patients to investigate the risk factors those influence their postoperative QOL, provide more preoperative evaluation tools for clinical physicians, and improve postoperative outcomes of patients with valvular heart disease. However, it is now just the beginning to use SF-36 to examine QOL of valvular heart disease patients. Because of significant differences in sample size, follow-up period, country and culture, current research has some controversial results. This review focuses on the progress in evaluating QOL in postoperative patients with valvular heart disease using SF-36.
Objective To investigate the treatment and prognosis of moderate ischemic mitral regurgitation (IMR) in coronary artery disease(CAD). Methods From January 1998 to May 2006, 28 patients of CAD with moderate IMR underwent coronary artery bypass grafting (CABG) and mitral valve plasty(MVP, 24) or mitral valve replacement (MVR,4). The Reed method were used in 9 cases, the annuloplasty ring were used in 15 cases. Mechanical valve were implanted in 1 case and biological valve in 3 cases. Results There was no operative or hospital death. Twentysix patients were followed up to a mean period of 41 months. There were two late death(one was MVP, the other was MVR). In MVP cases, nineteen patients were in New York Heart Association (NYHA) functional class Ⅰ and Ⅱ, 3 in class Ⅲ, which was better than that of preoperative one. Ultrasonic cardiography (UCG) examination showed no mitral regurgitation in 5 cases, mild in 7, light in 6, moderate in 3, severe in 1. Left atrial volume (LAV) and left ventricular enddiastolic volume (LVEDV) were 54.1±12.7ml and 60.9±14.8 ml, decreased more significantly than that preoperatively (Plt;0.05). In MVR cases, 2 cases were survival and followed. One patient was in NYHA functional class Ⅰ, 1 in class Ⅱ, which was better than that of preoperative one. Conclusion Moderate IMR with CAD should be treated carefully. MVP with annuloplasty ring have better early results. For patients with bad heart function and abnormal left ventricular wall motion, the late results need more studies.
Abstract:Objective To summarize the experiences in surgical treatment of ascending aortic root aneurysms. Methods One hundred and one patients （age ranging from 14 to 72 years, mean 42.7 years） with ascending aortic root aneurysms were diagnosed as having Marfan syndrome （58 cases）, annuloaortic ectasia （34 cases）, bicuspid aortic valve （5 cases）, aorto arteritis （4 cases） combined with aortic valve incompetence （96 cases） and aortic valve stenosis （4 cases） , preoperatively with type A dissection （26 cases） and acute left heart failure （5 cases）. Our operations consisted of 4 Wheat procedures, 13 Cabrol or modified Cabrol procedures, 1 David and 83 Bentall procedures. Concomitant operations included hemi-arch replacement or descending aorta intraluminal stent grafting （16 cases）, total arch replacement or descending aorta intraluminal stent grafting （4 cases）, mitral valve replacement or anuloplasty （14 cases） and coronary artery bypass grafting （CABG, 8 cases）. Results The overall mortality was 6.9%（7/101）, and decreased to 3. 6%（3/83） after the year 2000. Main postoperative complications were low cardiac output （10 cases）, respiratory insufficiency （9 cases）, and renal inadequacy （9 cases）. Follow-up was completed in 94 patients. During the period of follow-up, one patient died and 5 patients with Marfan syndrome suffered with type B dissection. Conclusion Bentall procedure is the method of choice for ascending aortic root aneurysms. Preoperative left heart function and surgical techniques give the crucial impact on the outcome of surgery.