ObjectiveTo analyze the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis.MethodsWe retrospectively analyzed the clinical data of 40 patients with ventricular septal defect complicated with infective endocarditis in our hospital from 2001 to 2016. There were 25 males and 15 females, aged 20-62 (39.92±11.16) years. They were divided into two groups according to the duration from admission to surgery: a group A (an early operation group whose surgery was performed within 7 days after admission) and a group B (a conventional treatment group with the duration from admission to surgery>7 days). Among them, there were 27 patients in the group A including 15 males and 12 females with an average age of 39.56±11.80 years, and 13 patients in the group B including 10 males and 3 females with an average age of 40.69±10.13 years. All patients were examined by echocardiogram and blood bacterial culture to investigate their etiology, echocardiogram results and treatment status. And the clinical data of the two groups were compared.ResultsTwo patients died before operation in the group B, one died of heart failure, and one cerebral infarction. No reoperation during hospitalization, cerebral infarction, thromboembolism or other complications occurred. The ventilation time in the group A was significantly shorter than that in the group B (18.00±14.85 h vs. 31.00±29.57 h, P=0.015). There was no statistical difference in the extracorporeal circulation time, myocardial block time, or postoperative hospital stay between the two groups (P>0.05). After discharge, the patients continued antibiotic therapy for 3-6 weeks. Patients were followed up for 12-127 (75.74±6.01) months, 1 died of malignant tumors in the group A, 1 developed atrial fibrillation and 1 developed cardiac insufficiency in the group B, and the rest of patients did not complain of obvious discomfort. There was no residual shunt, recurrence of infective endocarditis, reoperation, postoperative stroke or thromboembolism.ConclusionPreoperative echocardiography and blood bacteriological culture are helpful for the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis. Early surgery is safe and effective for these patients, and can improve the long-term survival rate.
Objective To investigate the effect of edgetoedge mitral valve plasty on left ventricular diastolic function and in order to find the validity and safety of this procedure. Methods From Feb. 2006 to Dec. 2007, thirty cases with mitral regurgitation were divided into two groups. Quadrangular resection was performed on fifteen cases with posterior proplapse in control group, and edgetoedge mitral valve plasty was performed on fifteen cases with anterior or bileaflet proplapse in experimental group, and ring annuloplasty(Medtronic ring) was used in both groups. The hemodynamics were monitored and recorded with SwanGanz catheter at the time of postoperation，2 h, 4 h, 6 h and 12 h after operation. Left ventricular diastolic function was also evaluated with echocardiography using color Doppler and tissue Doppler imaging in the patients with sinus rhythm. The ratio of the peak E velocity and A velocity(E/A), the ratio of the early diastolic peak flow velocity to the early diastolic mitral valve annular movement velocity(E/Em), and the ratio of early diastolic mitral valve annular movement velocity to late diastolic mitral valve annular movement velocity（Em/Am）were measured before operation and 1 week after operation respectively. Results Mitralvalve area were significantly reduced at 1 week after operation compared with that before operation in both groups (control group 3.63±1.06 cm2 vs. 7.18±2.41 cm2, experimental group 3.44±1.02 cm2 vs. 6.51±3.06 cm2, Plt;0.05）; and mitral regurgitant grade were significantly reduced at 1 week after operation in both groups as well(control group 0.53±0.64 cm2 vs.3.60±0.51 cm2, experimental group 0.67±0.82 cm2 vs.3.40±0.63 cm2, Plt;0.05). However, there was no significant difference for mitral valve area and mitral regurgitant grade between two groups before and after operation（Pgt;0.05）. In experimental group, there were no significant change of evaluations of E/A,E/Em and Em/Am before and after operation（E/A 1.28±0.36 vs. 1.95±1.06,E/Em 8.79±2.16 vs. 8.13±3.02, Em/Am 1.39±0.38 vs. 1.31±041，Pgt;0.05). There was no significant change of pulmonary artery wedge pressure (PAWP) before and after operation between two groups（13.60±4.37 mm Hg vs.12.20±3.53 mm Hg, Pgt;0.05）. Conclusion Edgetoedge mitral valve plasty technique is available and has no significant influence on left ventricular diastolic function, and a doubleorifice mitral valve has similar hemodynamic change compared with a physiological mitral valve.
ObjectiveTo summarize and analyze the clinical outcomes of one-stage transcatheter aortic valve replacement (TAVR) combined with transcatheter mitral valve replacement (TMVR) in patients with concomitant severe aortic and mitral valve disease. Methods We retrospectively collected the clinical data of patients who underwent one-stage TAVR and TMVR at Beijing Anzhen Hospital between January 2019 and May 2025. Baseline characteristics, procedural details, and perioperative echocardiographic results were recorded. Survivors were followed regularly, and the incidence of major adverse cardiovascular and cerebrovascular events was assessed. ResultsA total of 12 high-risk patients with concomitant severe aortic and mitral valve disease were included, comprising 7 males with a mean age of (73.3±5.4) years. Aortic valve pathology included mixed lesions (n=1), aortic regurgitation (n=8), and aortic stenosis (n=3). Among them, 7 patients had previously undergone surgical bioprosthetic aortic valve replacement. Mitral valve pathology consisted of bioprosthetic valve degeneration leading to isolated regurgitation (n=8) or mixed lesions (n=4); 11 patients had a prior surgical bioprosthetic mitral valve replacement. All patients successfully underwent one-stage TAVR combined with TMVR, with 10 procedures performed via the transapical approach, 1 via the transfemoral approach, and 1 via a combined transfemoral-transapical approach. Valve deployment was successful in all cases, with an overall device success rate of 91.7%. The median intensive care unit stay was 1.5 (IQR 1.3, 3.4) d. Early postoperative complications included 2 perioperative deaths and 2 cases of gastrointestinal bleeding, with no other major cardiovascular events observed. During follow-up, there were no deaths, permanent pacemaker implantations, and no occurrences of moderate-to-severe valve stenosis, paravalvular leak, or left ventricular outflow tract obstruction. Conclusion This study demonstrates that one-stage TAVR combined with TMVR is safe and effective in selected high-risk patients with concomitant severe aortic and mitral valve disease, and represents a feasible therapeutic option.
ObjectiveTo analyze the differences in clinical outcomes between sutureless aortic valve replacement (SUAVR) and conventional aortic root enlargement (ARE) techniques in patients with small aortic annulus (SAA). MethodsSAA patients undergoing aortic valve replacement at Beijing Anzhen Hospital, Capital Medical University from April 2018 to January 2025 were retrospectively enrolled. Patients were divided into a SUAVR group and an ARE group (including Nicks technique and Manouguian technique) according to surgical approaches. The primary endpoints were postoperative maximum transvalvular pressure gradient and indexed effective orifice area (iEOA). After adjusting for confounding factors using analysis of covariance, the differences in iEOA among the three surgical procedures were compared. ResultsA total of 56 SAA patients were included, with 26 patients in the SUAVR group and 30 patients in the ARE group (19 patients using Nicks technique and 11 patients using Manouguian technique). The median age of SUAVR group was significantly higher than that of ARE group (62.5 years vs. 57.5 years, P=0.035). Female proportions were 84.6% and 83.3%, respectively. In the ARE group, 73.3% of the patients received mechanical valve implantation and 1 patient died during the perioperative period. Postoperative transvalvular pressure gradient was lower in the SUAVR group compared to that in the ARE group [11.5 (8.3, 23.5) mm Hg vs. 19.0 (16.0, 26.0) mm Hg, P=0.005]. Significant differences existed in iEOA among the three techniques (P<0.001): Nicks group (1.10±0.14) cm2/m2, Manouguian group (1.27±0.16) cm2/m2, with SUAVR group showing the highest value (1.69±0.18) cm2/m2. After adjusting for confounding factors, SUAVR still demonstrated significantly higher adjusted iEOA than both Nicks and Manouguian groups (P<0.001). One patient in the ARE group developed moderate prosthesis-patient mismatch. No permanent pacemaker implantation occurred. ConclusionAmong this cohort of SAA patients, those receiving conventional ARE are younger with higher rates of mechanical valve implantation. SUAVR demonstrates favorable perioperative safety while achieving comparable hemodynamic performance to conventional ARE techniques, with significant advantages in iEOA. SUAVR can serve as an effective complementary strategy to traditional ARE techniques in selected SAA patients.