Objective To investigate the clinical efficacy of minimally invasive mitral valvuloplasty (MVP) in the treatment of infective endocarditis (IE) with mitral regurgitation (MR). Methods A retrospective analysis was conducted on the clinical data of patients who underwent MVP for IE with MR at the Department of Cardiovascular Surgery in Zhongshan Hospital, Fudan University from 2016 to 2020. Patients were divided into two groups based on the surgical incision: those with a right mini-thoracotomy were classified as a minimally invasive surgery (MIS) group, and those with a median sternotomy (MS) were classified as an MS group. All patients had isolated mitral valve involvement. Perioperative data were analyzed, and mid- to long-term outcomes were compared between the two groups. Results A total of 86 patients were included, with 40 in the MIS group [22 males and 18 females, with a mean age of (39.78±15.36) years ranging from 14 to 75 years] and 46 in the MS group [27 males and 19 females, with a mean age of (49.94±16.13) years ranging from 14 to 71 years]. The patients in the MIS group were relatively younger (P=0.004) with better preoperative cardiac function (P=0.004). There was no statistical difference in preoperative fever, gender, or comorbidities between the two groups (P>0.05). The MIS group had shorter postoperative ventilation times, less postoperative 24-hour drainage, less blood transfusion, and shorter total hospital stays compared to the MS group (P＜0.05). There was no statistical difference in cardiopulmonary bypass times or ICU stays between the two groups (P>0.05). The perioperative complication rates and mortality rates were not significantly different between the two groups (P>0.05). Follow-up was conducted for 11-92 months, with a mean duration of (49±19) months and an overall follow-up rate of 91.9%. During the follow-up, 3 patients in each group required reoperation for mitral valve issues, with no statistical difference in incidence (7.5% vs. 6.5%, P=0.691). There were no warfarin-related complications, recurrences, or deaths in either group during follow-up. Multivariate regression analysis identified age, preoperative cardiac function, and surgeon experience as influencing factors for the choice of surgical approach. Conclusion Minimally invasive MVP for IE with MR is relatively safe in the perioperative period and shows significant efficacy, with clear mid- to long-term outcomes. It is recommended for younger patients with better preoperative cardiac function and when performed by surgeons with extensive experience in mitral valvuloplasty.
Objective To investigate the correlation between cervical sagittal imbalance, disc morphology, and localized ossification of the posterior longitudinal ligament (LOP) in patients with single-level cervical disc herniation. Methods A cross-sectional study was conducted on 150 patients with single-level cervical disc herniation and complete imaging data (including standard X-ray film, CT, and MRI). Patients were divided into the LOP(+) group (n=76, with LOP at the herniated segment) and the LOP (?) group (n=74, without LOP) based on the presence of LOP. Univariate and logistic regression analyses were performed to identify factors associated with LOP, including gender, age, body mass index, C-reactive protein, fasting blood glucose, serum uric acid, maximum diameter of herniated disc, the maximum base width of herniated disc, spinal canal occupancy rate, height of intervertebral space, Pfirrmann grade of disc degeneration, C2-7 Cobb angle, T1 slope, cervical sagittal vertical axis (cSVA), C2-7 Cobb angle in extension/flexion, global cervical range of motion (ROM), and extension/flexion angle and ROM at the index level. Pearson or Spearman correlation was used to analyze the correlation of the main imaging parameters between the two groups. Results Univariate analysis showed that Pfirrmann grade, maximum base width of herniated disc, spinal canal occupancy rate, height of intervertebral space, C2-7 Cobb angle, extension angle and ROM at the index level were the influencing factors of LOP (P<0.05). Further logistic regression analysis revealed that the increase of the maximum base width of the herniated disc and the decrease of the spinal canal occupancy rate were the independent influencing factors of LOP (P<0.05). Correlation analysis showed that the correlation patterns among the main radiological parameters were not identical between the LOP (?) and LOP (+) groups. In both groups, the C2-7 Cobb angle was positively correlated with T1 slope (P<0.05), and some segmental motion parameters were correlated with global cervical ROM and dynamic C2-7 Cobb parameters (P<0.05). In the LOP (+) group, spinal canal occupancy rate, cSVA, OPLL thickness, and disc morphological parameters also showed certain correlations (P<0.05). Conclusion Cervical sagittal imbalance (characterized by reduced lordosis and segmental mobility) and disc base expansion are significantly associated with LOP coexistence in single-level cervical disc herniation patients. These imaging markers may aid early identification of high-risk populations in clinical settings.