Objective To evaluate the surgical effects of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins stripping on primary deep venous valvular incompetence of the lower limb.Methods Seventy-eight patients (92 limbs) with primary deep venous valvular incompetence of the lower limbs received the operations of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins from 1997 to 2004. There were 65 males and 13 females, and their ages ranged from 32 years to 72 years (mean age of 52.5 years). The valvular reflux grades of these 92 limbs varied from Ⅲ to Ⅳ according to Kistner’s standard. A sleeve made from the stripped great saphenous vein was used in the indirect loop valvuloplasty of the superficial femoral vein. The early results of surgery were retrospectively analyzed. Results Pre-operative symptoms, such as edema, ulceration, pigmentation and heavy feeling of the performed limbs disappeared or were remarkably improved in 65 cases (76 limbs) after operation. Eight cases (10 limbs) had alleviative symptoms compared with pre-operative ones. Meanwhile, no improvement of symptoms was observed in 3 patients (4 limbs). Acute ilio-femoral vein thrombosis occurred in 2 patients (2 limbs), which manifested as more servious edema of the lower limbs than those before operation. The overall effective rate of surgery was 93.5%（86/92）, and the complications rate was 2.2% (2/92). Conclusion Indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose vein stripping is an effective and convenient way to correct the primary deep venous valvular incompetence of the lower limb. The surgical indications of this disease should be emphasized strictly to assure the good outcomes.
The clinical results of one-staged indirect valvuloplasty of the superficial femoral vein by wrapping an autogenous saphanous vein cuff to treat 20 patients with primary valvular incompetence of deep vein. The results following postoperative follow-up were 16 patients ahd striking improvement, excellent improvement in 2. venuos thrombosis in 1 and one failure. The operative procedure was introduced, the indications for operation was discussed, and the results were vealuated.
目的 探討四維經食管超聲心動圖（4D-TEE）在瓣膜修復中的作用。 方法 2016 年 1 月我院對 3 例行二尖瓣修復和 1 例行主動脈瓣膜修復的患者采用西門子 SC2000 4D-TEE 進行術前術后評估，其中男 2 例、女 2 例，年齡38～59 （48.0±10.5）歲。同期采用二維經食管超聲心動圖指導二尖瓣和主動脈瓣修復的 13 例患者作為對照，其中男 8 例、女 5 例，年齡43～67（56.4±7.5）歲。 結果 術中 4D-TEE 可實時顯示瓣葉的各項參數，如不同節段瓣葉高度、交界區面積、瓣葉面積、對合面的大小、竇管交界大小，瓣膜運動形態、主動脈管壁位移等信息。可根據內置軟件建立個性化的瓣膜幾何模型，動態模擬瓣膜啟閉并直觀呈現。對照組僅可顯示某切面的瓣膜、腱索、乳頭肌、心腔等信息。 結論 4D-TEE 跳過了對二維圖像的解讀步驟，更直觀完整地顯示了瓣膜形態和動態，可以通過它的輔助來進行更有效的手術決策。
目的總結左心功能低下的冠心病合并瓣膜病變26例患者的外科治療效果及經驗體會。 方法回顧性分析2009年1月至2013年6月福建省立醫院左心功能低下（左心室射血分數＜50%）的冠狀動脈旁路移植術+瓣膜置換或成形術26例患者的臨床資料，其中男15例、女11例，年齡52～72（65.3±8.7）歲。 結果全組均痊愈出院。體外循環時間（156.6±29.4）min，升主動脈阻斷時間（76.2±28.8）min，術后呼吸機輔助時間（80.8±22.8）h，住ICU時間（5.6±2.8）d，術后住院時間（18.6±9.3）d，術后血管活性藥物應用時間（7.1±1.9）d，全組未使用主動脈內球囊反搏及心臟輔助裝置，術后7 d復查心臟彩超，左心室射血分數［45.5%±3.3%（42%～49%）］與術前差異無統計學意義（P＞0.05），左心室舒張期末內徑（LVEDD）［（5.1±1.2）］ cm與術前差異有統計學意義（P＜0.05）。 結論左心功能低下的冠心病合并瓣膜病變非手術禁忌，行冠狀動脈旁路移植術加瓣膜手術可以取得良好手術療效。
Objective To evaluate the surgical characteristics, methods and clinical effect of pediatric valvoplasty through an analysis of valvoplasty in children in the age from 15 h to 14 years. Methods From January 1993 to June 2003, 376 children underwent valvoplasty. There were 349 cases (92.8%) of congenital heart disease and 27 cases(7.2%) of acquired heart disease. The procedure included mitral valvoplasty in 79 (19.4%), tricuspid valvoplasty in 159 (39.1%), aortic valvoplasty in 40 (9.8%), and pulmonary valvoplasty in 129(31.7%). Results There were 12 early deaths (3.2%) after the procedure. 297 patients were followed up from 1 month to 10 years (mean, 4.9±2.4 years). There were 2 late deaths (0.7%) after discharge. There were 5 cases (1.7%) of re-operation due to valve problem. Conclusions Valvoplasty should be the first choice in dealing with valve diseases in children. The effect of the valvoplasty works on the prognosis of the operation.
Abstract： Surgical repair of functional tricuspid regurgitation (FTR) is often carried out concomitantly with other leftsided heart valve procedures. Though diseases of both left heart valve and tricuspid were treated during the surgery, postoperative residual or recurrent tricuspid regurgitation has been clearly associated with progressive heart failure and worsened longterm survival. To date, surgical interventions mainly address FTR at three anatomic levels: commissure, annulus and leaflets. However, a certain mid and longterm failure rate after operation still exists. High surgical mortality rates have been reported in patients with recurrent tricuspid regurgitation requiring complex reoperations. With a better understanding of tricuspid anatomical complex and valvuloplasty, significant improvements have been made in FTR surgical indications and techniques. This review article will focus on the development of surgical indications in tricuspid valve repair, while the repair techniques and their impact on longterm clinical outcome will also be compared.
Objective To analyze the early prognosis of repairing adult aortic insufficiency with the Florida sleeve procedure. Methods The patients with aortic insufficiency who underwent Florida sleeve repair in the Nanjing First Hospital, Nanjing Medical University between August 2020 and May 2024 were selected. Their general data, perioperative conditions, and echocardiographic data before, during, and after the procedure and at follow-up were analyzed. Results Fifteen patients were included, consisting of 12 males and 3 females, aged 33-71 (53.5±12.4) years. Preoperative echocardiography indicated that there was 1 patient of rheumatic disease, 7 patients of degenerative disease, 4 patients secondary to aortic aneurysm, and 3 patients of bicuspid aortic valve. The severity distribution included 2 patients of severe insufficiency, 4 patients of moderate-to-severe insufficiency, 5 patients of moderate insufficiency, and 4 patients of mild-to-moderate insufficiency. The mean cardiopulmonary bypass time was (135.0±40.0) minutes, the aortic cross-clamp time was (109.9±38.6) minutes, and the median ICU stay was 1.0 day. No mortality was recorded within 30 days postoperatively. Follow-up echocardiography showed that the valve regurgitation, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and sinus diameter all achieved the desired outcomes. Conclusion Florida sleeve repair for aortic valve in patients with a sinus diameter less than 50 mm not only effectively improves hemodynamics in adults with aortic insufficiency, but also has the advantages of low surgical risk and rapid postoperative recovery, making it a promising procedure for clinical application.
ObjectiveTo investigate the prognosis and risk factors of mild to moderate or moderate atrioventricular valve regurgitation (AVVR) after Fontan operation.MethodsA total of 34 patients with mild to moderate or moderate AVVR who accepted Fontan operation and atrioventricular valve (AVV) repair between 2004 and 2018 in our center were selected as an AVV repair group. The patients in the same period were matched as a control group by the ratio of 1 : 1-2. Finally 99 patients were included into this study, including 64 males and 35 females, with an average age of 63.4±36.3 months and weight of 17.3±6.7 kg. Grades of AVVR decreased more than 1 was defined as significant improvement. Endpoints of the study were death, Fontan takedown, AVV replacement. Risk factors including Fontan procedures, AVV repair procedures, cardiac anatomy were analyzed.ResultsPatients were followed up for 1.5 (0.3-4.0) years. Overall mortality was 15.2%. Most (82.4%) of AVV repair group accepted single AVV repair procedure while partial annuloplasty was the most common (52.9%). With the extension of follow-up, the degree of AVVR in the whole group showed a gradually increasing trend (r=0.352, P=0.000). Mild to moderate AVVR improved spontaneously after Fontan operation, while moderate AVVR did not. AVV repair could improve the degree of AVVR after moderate regurgitation, without increasing the surgical mortality, and regurgitation significantly decreased in 8.8% patients. AVV repair was not effective for mild to moderate AVVR and would increase surgical mortality. ConclusionAVV function shows a gradual downward trend after Fontan operation. AVV repair is effective for moderate AVVR, does not increase mortality, but the degree of improvement is limited. AVV repair is not effective for mild to moderate AVVR and increases surgical mortality.
Abstract: Objective To summarize the clinical results of homemade flexible annuloplasty ring in mitral valve repair, in order to discuss the appropriate ring size. Methods Sixtysix patients (55 males,and 11 females with a mean age of 44.62±15.94 years) with mitral insufficiency underwent mitral valve repair with homemade flexible annuloplasty ring from April 2002 to November 2009 in Fu Wai Hospital. In order to choose the ring with an appropriate size, we made and kept to the following principles: if the intercommissural distance was bigger than size 30, we chose a ring 2size smaller; if the measured distance was smaller than size 30, 1size smaller ring would be chosen. Patients were followed by echocardiography to observe the mitral valve function. Results All patients were cured and discharged from the hospital. The results of echocardiography showed mild to moderate regurgitation in 1 patient, mild regurgitation in 11 patients, and normal mitral function or trace regurgitation in the rest 54 patients. Mitral valve forward velocity was 1.40±0.30 m/s with no mitral stenosis or systolic anterior motion (SAM) of the anterior mitral leaflet. Fiftyone patients were followed up from 2 months to 7 years(24.60±25.90 months). The results of echocardiography on 38 patients showed that 1 patient had moderate regurgitation, 5 patients had mild to moderate regurgitation, 9 patients had mild regurgitation and others had normal mitral function or trace regurgitation. For these 38 patients included in the followup study, mitral valve forward velocity was 1.50±0.40 m/s with no mitral stenosis, SAM or left ventricular outlet tract obstruction. During the followup, the left atrium size (43.19±10.48 mm vs. 48.59±9.40 mm, t=4.524, P=0.000) and left ventricular end diastolic diameter (52.64±7.35 mm vs. 6269±8.77 mm, t=7.607, P=0.000) decreased significantly than the preoperative size and diameter respectively. The application of restrictive homemade flexible annuloplasty ring in mitral valve annuloplasty had satisfactory, durable and stable clinical results.