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.
ObjectiveTo analyze the clinical efficacy of valve surgeries for infective endocarditis and the affecting factors, and compare the early- and long-term postoperative outcomes of different surgery approaches. MethodsThe patients with infective endocarditis who underwent valve replacement/valvuloplasty in our hospital from 2010 to 2022 were retrospectively collected. The clinical data of the patients were analyzed. ResultsA total of 343 patients were enrolled, including 197 patients with mechanical valve replacement, 62 patients with bioprosthetic valve replacement, and 84 patients with valvuloplasty. There were 238 males and 105 females with an average age of (44.2±14.8) years. Single-valve endocarditis was present in 200 (58.3%) patients, and multivalve involvement was present in 143 (41.7%) patients. Sixty (17.5%) patients had suffered thrombosis before surgery, including cerebral embolisms in 32 patients. The mean follow-up time was (60.6±43.8) months. Early mortality within one month after the surgery occurred in 17 (5.0%) patients, while later mortality occurred in 19 (5.5%) patients. Eight (2.3%) patients underwent postoperative dialysis, 13 (3.8%) patients suffered postoperative stroke, 6 patients underwent reoperation, and 3 patients suffered recurrence of infective endocarditis. Smoking (P=0.002), preoperative embolisms (P=0.001), duration of surgery (P=0.001), and postoperative dialysis (P=0.001) were risk factors for early mortality, and left ventricular ejection fraction ≥60% (P=0.022) was protective factor for early mortality. New York Heart Association classification Ⅲ-Ⅳ (P=0.010) and ≥3 valve procedures (P=0.028) were risk factors for late mortality. The rate of composite endpoint events was significantly lower in the valvuloplasty group than that in the valve replacement group. ConclusionFor patients with infective endocarditis, smoking and preoperative embolisms are associated with high postoperative mortality, multiple-valve surgery is associated with a poorer prognosis, and valvuloplasty has advantages over valve replacement and should be attempted in the surgical management of patients with infective endocarditis.
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 report the experiences of cardiac valve operation in children. Methods Cardiac valve operations were performed in 87 children who were 58 male and 19 female between age of 4 to 14 years (mean 10.2 years). Of the 87 patients, 36 underwent mitral valve replacement, 13 aortic valve replacement, 6 mitral and aortic valve replacement, 13 aortic valvuloplasty, and 19 mitral valvuloplasty. Associated cardiac lesions were simultaneously managed. Results Postoperative complications included low car...
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.
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。
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.