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Prosthetic Valve Endocarditis

Abstract: Prosthetic valve endocarditis(PVE) is a catastrophic complication of cardiac valve replacement, associated with high mortality rates. In the past nearly five decades, the microbiology, pathophysiology, clinical features, and therapeutic options in PVE have changed a lot, and there are new insight into the pathogenesis of PVE. The current comprehensive review will address various issues involved in the diagnosis and management of this complication.

右心房膨出瘤二例

肺部隐球菌病伴隐球菌性脑膜炎一例

动脉导管未闭封堵术后残余漏二例

埃布斯坦综合征合并预激综合征的外科治疗

目的 为了提高手术疗效,总结埃布斯坦综合征(Ebstein syndrome)合并预激综合征的手术治疗经验. 方法 11例患者均有埃布斯坦综合征及严重三尖瓣关闭不全,合并A型预激综合征4例,B型 7例.术中电生理标测显示11例中有12条附加旁道,右心室游离壁6例,左心室游离壁3例,后间隔1例,后间隔和右心室游离壁双旁道1例.所有患者的房室附加旁道均在体外循环下被成功地手术切割;埃布斯坦综合征按Danielson方法行成形术9例,三尖瓣置换术2例. 结果 全组11例无手术后早、晚期死亡;术后随访4个月～6年,平均随访3.4±1.3年,无预激综合征复发,2例有轻度三尖瓣关闭不全.心功能Ⅰ级9例,Ⅱ级2例. 结论 手术治疗埃布斯坦综合征合并预激综合征,可同时纠正埃布斯坦综合征伴三尖瓣关闭不全和预激综合征,治疗效果良好.

The analysis of mitral valve replacement on the old

Objective To study effects of mitral valve replacement(MVR) on the old with mitral valve diseases(MVD). Methods The documents of 265 cases undergoing MVR were reviewed, who aged 60 years old or over between June 1991 and June 2003. Demographices, clinical preoperative conditions, indications to surgery, early postoperative course and long-term outcome were collected via hospital documents and outpatient follow-up. Many risk factors were analysed. Results Follow-up rate amounted to 93.7%(236/252). The mortality was 4.9% (13/265) within 30 days. Heart failure and renal failure were the main cause of death. Compared with younger patients(lt;60 years old), long-term survival rate was lower in the old, 5-year 87.52% vs 96.84%, 10-year 81.23% vs 94.87%. There were 15 late deaths(0.17% case/M), most of whom died of heart failure, cancers and lung infections. Risk factors for MVR in the old included New York Heart Association class Ⅳ, diabetes, and lung incompetence. Conclusions The patients with MVD over 60 years old tended to present high postoperatively mortality and morbidity.

复制缺陷的重组腺病毒载体直接转染猪慢性缺血心肌的研究

目的 建立猪慢性心肌缺血模型,评价腺病毒载体的转染效率和持续时间. 方法 应用磷酸钙沉淀法制备携带大肠杆菌LacZ基因复制缺陷的重组腺病毒(Ad.LacZ),将健康家猪8条随机分为实验组和对照组,每组4条.两组猪均经左前外侧开胸,于冠状动脉左回旋支(LCX)放置Ameroid环, 28天后二次开胸,实验组:在缺血心肌部位每点直接注射Ad.LacZ 100μl,1010噬斑形成单位,共10点;对照组:在缺血心肌部位每点注射磷酸盐缓冲液(PBS)100μl,共10点.于注射后3天、7天和28天对缺血心肌进行染色和病理观察. 结果 冠状动脉造影证实LCX完全闭塞,心肌有缺血和小面积心肌梗死;实验组注射Ad.LacZ后第3天、7天和28天X-gal染色有阳性细胞,以7天时明显,对照组无阳性细胞. 结论 应用Ameroid环可成功建立猪慢性心肌缺血模型,腺病毒载体转染缺血心肌基因表达可持续4周.

胸主动脉夹层的再次手术治疗

目的分析胸主动脉夹层术后复发的原因,总结其外科治疗经验。方法回顾分析4例主动脉夹层术后复发患者行手术治疗的临床资料,其中行Bentall手术2例,胸主动脉置换术2例。结果全组无手术死亡,术后并发呼吸及肾功能不全1例,声音嘶哑1例。结论胸主动脉夹层术后再发与原发病、血压控制不良、第1次手术适应证的选择有关,急性DeBakeyI、II型患者应行急诊手术治疗。

应用自体心包瓣置换术治疗主动脉瓣病变

目的　报告无支架自体心包瓣置换主动脉瓣手术的临床应用效果。　方法　11例单纯主动脉瓣病变患者行自体心包瓣置换主动脉瓣手术，术后定期随访。　结果　11例均存活，顺利出院，随访时间5～30个月，平均随访时间24.2±5.6个月。1例因中等量反流而行二次手术，其余10例心包瓣膜功能良好。　结论　该手术是一种治疗单纯主动脉瓣病变较为理想的方法，术后患者无需长期抗凝，手术近期效果满意，远期效果有待进一步随访。

心内直视手术后气管切开及其处理方法