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find Keyword "三尖瓣置换" 28 results
  • Mid and Long Term Outcomes of the Morphologic Tricuspid Valve Replacement for Patients with Corrected Transposition of the Great Arteries

    Objective To investigate the surgical indications and the mid and long term results of morphologic tricuspid valve replacement for corrected transposition of the great arteries(cTGA). Methods From September 1997 to September 2007, 18 cases with cTGA were treated in Fu Wai Hospital. There were 15 male and 3 female, aged from 16 to 51 years(33.3±12.8 years), and weighed from 47 to 90 kg(60.9±14.7 kg). There were 10 cases with isolated morphologic tricuspid valve insufficiency, 3 complicated with ventricular septal defect, 2 complicated with ventricular septal defect and pulmonary valve stenosis, 2 with morphologic tricuspid valve insufficiency after septal defect repair, and 1 with mechanical valve dysfunction after morphologic tricuspid valve replacement. The preoperative mean morphologic right ventricle ejection fraction was 562%±11.6%. Of the 18 cases, 12 were in grade Ⅱ and 6 were in grade Ⅲ according to New York Heart classification(NYHA).All the cases had undergone morphologic tricuspid valve replacement. Postoperative indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results One patient died of postoperative low cardiac output syndrome. Two had pervavlvular leak, which were cured by pervavlvular leak repair at 7th and 30th day after operation, respectively. Sixteen were followed up with a followup time of 57.0±407 months. There was no statistical significance between preoperative and postoperative mean morphologic right ventricle ejection fraction(52.8%±9.2% vs.56.2%±11.6%; t=2.062, Pgt;0.05). The followup showed that 12 were in NYHA grade Ⅰ or Ⅱ, and 4 were in NYHA grade Ⅲ. There was no statistical significance between preoperative and postoperative percentage of cases in NYHA grade Ⅲ(χ2=1.532,Pgt;0.05). Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function caused by morphologic tricuspid valve insufficiency. The mid and long term results were satisfying. During the followup, the morphologic right ventricle can function appropriately.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 二尖瓣置换术后三尖瓣关闭不全的外科治疗

    目的总结二尖瓣置换术后三尖瓣关闭不全患者的外科治疗经验。方法14例心脏瓣膜疾病患者行二尖瓣置换术后发生中度或重度三尖瓣关闭不全,其中相对性关闭不全12例,器质性关闭不全2例。行三尖瓣成形术4例,均使用人工瓣环成形;行三尖瓣置换术10例,其中置换生物瓣6例,双叶机械瓣4例。在心脏不停跳下手术4例,常规心脏停搏手术10例。结果全组无手术死亡,术后发生低心排血量综合征3例,用升压药维持循环,患者均顺利出院。术后复查超声心动图,右心房、室均明显缩小,右心室前后径(22.5±5.6mm)较术前(31.9±5.9mm)明显减小(Plt;0.001)。随访14例,随访时间1.8±1.3年,心功能级2例、级9例,级2例,1例于术后4年因心力衰竭死亡。结论二尖瓣置换术后远期三尖瓣关闭不全的患者经外科矫治后疗效满意,合理掌握手术指征、手术时机和良好的围术期治疗是手术成功的关键。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • Effects of preoperative inspiratory muscle training on prevention of postoperative pulmonary complications in patients undergoing transcatheter tricuspid valve replacement

    Tricuspid valve, also known as "forgotten valve" because of the high natural and surgical mortality. Transcatheter tricuspid valve replacement is an innovative surgical method to treat tricuspid regurgitation, which improves the prognosis of patients and is gradually being popularized in clinics. However, postoperative pulmonary complications are still the main causes affecting the rapid recovery and death. More and more medical experts begin to use preoperative inspiratory muscle training to reduce postoperative pulmonary complications and improve the quality of life of patients after cardiac surgery. However, there was no report on the effect of preoperative inspiratory muscle training on pulmonary complications after transcatheter tricuspid valve replacement. Therefore, for the first time, we boldly speculate that inspiratory muscle training can reduce pulmonary complications after transcatheter tricuspid valve replacement, and put forward suggestions for its treatment mechanism and strategy. But this rehabilitation intervention lacks practical clinical research. Unknown challenges may also be encountered, which may be a new research direction.

    Release date:2022-09-20 08:57 Export PDF Favorites Scan
  • The Advance of Surgical Treatment of Ebstein Anomaly

    Abstract: Ebstein anomaly is a relatively rare congenital heart malformation which can affect heart function significantly. It may cause right heart failure, even whole heart failure and eventually death. In recent years, the surgery has made much progress in dealing with the abnormal valve, improving the right ventricle function and pretreatment of its related complications. However, because of its complexity and diversity in pathological anatomy and clinical manifestations, the disease has not got an “almighty standard” to treat all pathological anatomy types of the deformity, or asurgery strategy to solve the practical problems encountered in all clinic situations. Furthermore, the therapeutic effect is also unsatisfactory. This article will review the advance of treatment of Ebstein anomaly and prevention of its related complications.

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • Reoperative strategy and mid- to long-term surgical outcomes of Ebstein anomaly

    ObjectiveTo analyze the Ebstein anomaly's reoperative strategy and mid- to long-term results.MethodsWe retrospectively reviewed the clinical data of 23 patients who diagnosed with Ebstein anomaly and underwent reoperation for tricuspid valve insufficiency between July 2002 and July 2017 in Fuwai Hospital. There were 9 (39.1%) males and 14 (60.9%) females, with a median age of 28.0 (19.0, 45.0) years.ResultsAmong the 23 patients, 8 (34.8%) underwent tricuspid valvuloplasty and 15 (65.2%) underwent tricuspid valve replacement. The rate of valvuloplasty was 16.7% before 2012, and 54.5% after 2012 (P=0.089) as Cone reconstruction procedure was used. In the valvuloplasty cohort, 3 (37.5%) patients were treated with Danielson or Carpentier technique, and 5 (62.5%) patients were treated with Cone reconstruction procedure. There was no operation-related death. Early complications occurred in 3 (37.5%) patients. The median follow-up was 6.9 years (range, 3.0-15.1 years), and no adverse cardiac events occurred. In the patients with valve replacement, 7 (46.7%) received mechanical prosthesis and 8 (53.3%) received bio-prosthesis. There was no operation-related death. And early complications were observed in 3 (20.0%) patients. The median follow-up was 6.5 years (range, 2.5-15.3 years). One (6.3%) patient died and 4 (26.7%) had long-term complications during the follow-up period.ConclusionThe mid- to long-term outcomes are convincing in patients who undergo the second operation due to recurrent tricuspid regurgitation of Ebstein anomaly. A low incidence of reoperation is observed. Cone reconstruction procedure provides possibilities of second tricuspid valvuloplasty, and this technique can reduce the rate of tricuspid valve replacement in the second operation. Tricuspid valve replacement is still an alternative method for the treatment of recurrent tricuspid regurgitation in patients with Ebstein anomaly. The bioprosthetic prosthesis may be a better choice than mechanical prosthesis.

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  • Early and Mid-term Outcomes of Morphologic Tricuspid Valve Replacement with Preservation of Entire Valvular and Subvalvular Apparatus in Corrected Transposition of Great Arteries

    Abstract: Objective To investigate the early and mid-term outcomes of morphologic tricuspid valve replacement by means of intravalvular implantation in corrected transposition of great arteries(cTGA). Methods From January 2009 to January 2012,11 patients with cTGA were surgically treated in Fu Wai Hospital. There were 9 male patients and 2 female patients with their mean of age of(37.8±11.7)years and mean body weight of(73.0±11.3)kg. All the patients underwent morphologic tricuspid valve replacement with preservation of the entire valvular and subvalvular apparatus. Simultaneous surgical procedures included repair of ventricular septal defect in 2 patients,repair of atrial septal defect in 4 patients,pulmonary valvuloplasty in 1 patient,reconstruction of functional right ventricular outflow tract in 4 patients and repair of coronary-pulmonary artery fistula in 1 patient. Postoperative New York Heart Association (NYHA) classification, cardiothoracic ratio, morphological right ventricle ejection fraction, end-diastolic dimension of morphological right ventricle and left atrium were evaluated during follow-up. Results All the 11 patients were successfully surgically treated and followed up for an average duration of(13.0±10.6)months. There was no statistical difference between postoperative and preoperative average cardiothoracic ratio (0.54±0.06 vs. 0.57±0.09,t=1.581,P>0.05),morphologic right ventricle ejection fraction (52.8%±9.0% vs. 54.9%±9.5%, t =0.712,P>0.05),and end-diastolic dimension of . morphological right ventricle (54.3±7.5 mm vs. 56.9±9.2 mm,t =0.988,P>0.05). There was statistical difference between postoperative and preoperative average end-diastolic dimension of left atrium(42.1±8.9 mm vs. 53.4±11.1 mm,t =3.286,P<0.05)and NYHA classification(Z = -2.640,P<0.05). Conclusion Intravalvular implantation of morphologic tricuspid prosthesis can protect the physiological structure of morphologic right ventricular and prevent furtherdamage to its function caused by morphologic tricuspid valve insufficiency. Postoperative dimension of morphologic left atrium and cardiac function are significantly improved. The early and mid-term outcomes are satisfactory.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Clinical outcome of tricuspid valve replacement in children aged no more than 14 years

    ObjectiveTo summarize the clinical characteristics and outcome of tricuspid valve replacement (TVR) in children aged no more than 14 years, and to discuss the selection of prosthesis.MethodsFrom September 2002 to August 2019, 14 patients aged no more than 14 years who received TVR were included in our study. There were 9 males and 5 females, with a mean age of 9.8±4.3 years.ResultsMechanical prosthesis was implanted in 8 patients, and bioprosthesis in 6 patients. The mean cardiopulmonary time and aortic-clamp time was 170.3±109.8 min and 95.1±63.1 min, respectively. The mortality within 30 days after surgery was 21.4% (3/14), and all 3 patients died of severe low cardiac output syndrome. Eleven patients were followed up for 34-199 (100.1±57.4) months. During the follow-up, mechanical prosthesis dysfunction occurred in 3 patients, 2 of whom received secondary TVR. One patient died during the follow-up.ConclusionThe bioprosthesis is the first choice for TVR in children. Some long-term complications may occur after TVR, and close follow-up and timely intervention are needed.

    Release date:2020-12-07 01:26 Export PDF Favorites Scan
  • Transcatheter tricuspid valve replacement for severe tricuspid regurgitation: a case report and literature review

    ObjectiveTo explore the clinical effect of LuX-Valve implantation in patients with severe tricuspid regurgitation (TR) and review articles about similar devices.MethodsWe reported the data of a 58-year-old male patient with severe TR, who was hospitalized on March 17th, 2020 because of “abdominal distention and edema for 5 years”, and then received LuX-Valve implantation in the Department of Cardiovascular Surgery of Changhai Hospital, Naval Medical University. Articles about transcatheter tricuspid valve replacement were reviewed in PubMed according to the key words including “transcatheter tricuspid valve replacement” “TTVR” and “transcatheter tricuspid valve intervention”.ResultsThe patient with severe TR received LuX-Valve implantation under general anesthesia and the guidance of digital subtraction angiography and transesophageal echocardiography. The patient’s TR was totally corrected after implantation and postoperative one-month follow-up showed well clinical effects. The result of literature review showed that there were two similar devices and both had been implanted in TR patients.ConclusionLuX-Valve is an effective and reliable transcatheter tricuspid valve replacement device.

    Release date:2020-10-26 03:00 Export PDF Favorites Scan
  • Clinical analysis of outcomes of different surgery methods for Ebstein anomaly in a single center

    ObjectiveTo investigate the indications and clinical effects of tricuspid cone reconstruction and tricuspid valve replacement in the treatment of downward displacement of tricuspid valve (Ebstein anomaly).MethodsThe clinical data of 22 patients with Ebstein anomaly who underwent surgical treatment in our hospital from January 2013 to March 2020 were collected. There were 7 males and 15 females, aged 4-56 (33.68±17.78) years. The patients were divided into two groups according to different surgical methods: a tricuspid cone reconstruction group (tricuspid valvuloplasty group, n=12) and a tricuspid valve replacement group (n=10). The curative effect of the two operative methods were compared.ResultsTwenty-two patients underwent surgical treatment under general anesthesia and cardiopulmonary bypass. One patient died of severe low cardiac output syndrome during operation. Downward displacement of tricuspid septum was found in 22 patients, and downward displacement of tricuspid septum and posterior septum in 21 patients, downward displacement of tricuspid in 8 patients. Twelve patients were treated with tricuspid valvuloplasty, 10 patients with tricuspid valve replacement, and patients with other intracardiac structural malformations were treated at the same time. Postoperative cardiac doppler ultrasound indicated no tricuspid regurgitation in 9 patients, mild regurgitation in 8 patients, and moderate regurgitation in 4 patients. No perivalvular leakage occurred in all patients undergoing valve replacement. Four patients developed degree Ⅲ atrioventricular block after operation, among whom 3 patients recovered to sinus rhythm and 1 patient implanted the permanent pacemaker. Twenty-one patients were cured and discharged after successful operation, and were followed up for 3 to 78 months, with a follow-up rate of 100.0%. During the follow-up period, there was no severe tricuspid regurgitation in tricuspid valvuloplasty group, but mild or moderate regurgitation was found. After tricuspid valve replacement, only 1 patient had mild regurgitation, and the rest patients had no valve regurgitation.ConclusionTricuspid valvuloplasty and tricuspid valve replacement are effective in the treatment of Ebstein anomaly, and the tricuspid regurgitation is less severe after tricuspid valve replacement operation. The operation method should be selected according to the different anatomical characteristics and condition of tricuspid valve. The combined intracardiac malformation or arrhythmia can be dealt with simultaneously.

    Release date:2021-09-18 02:21 Export PDF Favorites Scan
  • 风湿性三尖瓣器质性病变的外科治疗

    目的 根据三尖瓣不同类型病变,探讨对三尖瓣器质性病变比较合理的处理方法. 方法 根据超声心动图检查及手术探查结果进行分析,依据不同病理改变决定手术方式,行三尖瓣器质性病变瓣膜成形术和瓣膜置换术53例.以瓣环扩大、瓣叶增厚、关闭不全为主的患者采用改良Kay法或节段性DeVega成形术;交界粘连融合以狭窄为主则切开交界融合,切开处以小垫片缩环,交界对拢缝合使前后瓣组成统一瓣;成形失败者行三尖瓣置换术.结果 采用改良Kay法或节段性 DeVega成形术43例,切开粘连交界对拢缝合5例,置换生物瓣1例,机械瓣4例.术后早期死亡3例.随访50例,随访时间5个月~9年,随访率为94%,其中1例5年后死于心力衰竭.超声心动图示三尖瓣无反流41例,轻至中度反流8例.心功能恢复到Ⅰ~Ⅱ级44例,Ⅲ级5例. 结论 三尖瓣器质性病变绝大部分均可采用瓣膜成形术,三尖瓣置换术的远期效果较为满意.

    Release date:2016-08-30 06:34 Export PDF Favorites Scan
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