Background： Percutaneous balloon pulmonary valvuloplasty （PBPV） is the preferred therapy for pulmonary valve stenosis （PVS）. This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim o...Background： Percutaneous balloon pulmonary valvuloplasty （PBPV） is the preferred therapy for pulmonary valve stenosis （PVS）. This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim of this study was to evaluate factors associated with immediate therapeutic outcomes and restenosis during medium-term follow-up. Methods： The study included 158 infants with PVS who underwent PBPV from January 2009 to July 2015. Demographic characteristics and patient records were reviewed, including detailed hospitalization parameters, hemodynamic data before and immediately after balloon dilation, cineangiograms,and echocardiograms before PBPV and at each follow-up.All procedures were performed by more than two experienced operators. Results： Immediately after balloon dilation, the pressure gradient across the pulmonary valve decreased from 73.09 ± 21.89 mmHg （range： 43-151 mmHg） to 24.49 ± 17.00 mmHg （range： 3-92 mmHg; P 〈 0.001） and the right ventricular systolic pressure decreased from 95.34 ± 23.44 mmHg （range： 60-174 mmHg） to 52.07 ± 18.89 mmHg （range： 22-134 mmHg; P 〈 0.001）. Residual transvalvular pressure gradientsof67.31±15.19mmHg（range：50-92mmHg）werefoundin8.2%ofpatients,indicatingpoortherapeuticeffects;6.4%ofpatientshad variable-staged restenosis at follow-up and 3.8% underwent reintervention by balloon dilation or surgical repairs. Further analysis demonstrated that the balloon/annulus ratio showed statistically significant differences（P 〈 0.05） among groups with different therapeutic effects and between the restenosis and no-stenosis groups. Binary logistic regression analysis further revealed that higher balloon/annulus ratio （odds ratio： 0.005, 95% confidence interval： 0-0.39） was an independent protective factor for restenosis. The rate of severe complications was 1.9%. Conclusions： PBPV is a definitive therapy for infants with PVS based on its effectiveness, feasibility, and safety. Restenosis upon medium-term follow-u展开更多
Background： Tricuspid regurgitation （TR） is frequently associated with severe mitral stenosis （MS）, the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of...Background： Tricuspid regurgitation （TR） is frequently associated with severe mitral stenosis （MS）, the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty （PBMV） procedure in rheumatic heart disease patients with mitral valve （MV） stenosis and tricuspid valve regurgitation. Methods： Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV： MV area （MVA）, TR area （TRA）, atrial pressure and diameter, and pulmonary artery pressure （PAP）. The patients were followed for 6 months to 9 years. Results： After PBMV, the MVAs increased significantly （1.7 ± 0.3 cm2 vs. 0.9 ± 0.3 cm2, P 〈 0.01）; TRA significantly decreased （6.3 ± 1.7 cm2 vs. 14.2 ± 6.5 cm2, P 〈 0.01）, right atrial area （RAA） decreased significantly （21,5 ± 4.5 cm2 vs. 25.4 ± 4.3 cm〈 P 〈 0.05）, TRA/RAA （%） decreased significantly （29.3 ± 3.2% vs. 44.2 ± 3.6%, P 〈 0.01）. TR velocity （TRV） and TR continue time （TRT） as well as TRV - TRT decreased significantly （ 183.4± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P 〈 0.01 ; 185.7 ± 13.6 ms vs. 238.6 ±l 1.3 ms, P 〈 0.01 ; 34.2 ±5.6 cm vs. 60.7 ± 8.5 cm, P 〈 0.01, respectively）, The postoperative left atrial diameter （LAD） significantly reduced （41.3 ± 6.2 mm vs. 49.8± 6.8 mm, P 〈 0.01） and the postoperative right atrial diameter （RAD） significantly reduced （28.7 ±5.6 mm vs. 46.5 ± 6.3 mm, P 〈 0.01 ）; the postoperative left atrium pressure significantly reduced （ 15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P 〈 0.01 ）, the postoperative right atrial pressure decreased significantly （ 13.2 ±2.4 mmHg vs. 18.5 ±4.3 mmHg, P 〈 0.01 ）. The pulmonary arterial pressure d展开更多
目的:评价改良迷宫术同期进行瓣膜手术的电生理效果及对心脏功能的远期影响。方法:24 例慢性房颤伴有二尖瓣疾病施行改良迷宫和二尖瓣手术的患者进行12导联心电图、心内电生理、动态心电图和超声心动图检查,平均随访(92.7±11.9)个...目的:评价改良迷宫术同期进行瓣膜手术的电生理效果及对心脏功能的远期影响。方法:24 例慢性房颤伴有二尖瓣疾病施行改良迷宫和二尖瓣手术的患者进行12导联心电图、心内电生理、动态心电图和超声心动图检查,平均随访(92.7±11.9)个月。结果:(1)术后3个月90%恢复窦性心律,术后1年以上100%恢复窦性心律。(2)除1例Ⅰ度房室传导阻滞外,窦房结及房室结功能检查均正常。(3)除高位右房外心房各部位有效不应期均显著延长,在心房各部位猝发和程控刺激均不能诱发房扑和房颤。(4)电生理检查有正常的心房激动和房室同步顺序。(5)动态心电图显示有良好的心率变时性反应和运动耐力。(6)随访期中再住院率为4%。(7)超声心动图显示随访期左房长径较术后明显减小[(5.52±1.22) cm vs (6.77±1.36) cm, P<0.01];随访期左房容积明显小于术后[(91.97±52.64) cm3vs(155.35±88.86) cm3, P<0.001];随访期右房长径明显小于术后[(4.72±0.85) cm vs (5.77±1.18) cm,P<0.05]。(8)左心室收缩功能正常,平均EF值为(56.00±19.75)%,平均FS值为(32.86±9.53)%。结论:在改良迷宫同时进行瓣膜手术均能安全有效的消除房颤维持窦律减小心房容积,恢复正常的房室同步传导和左心功能。展开更多
Background:Intrauterine valvuloplasty is an innovative therapy,which promotes ventricular growth and function in some congenital heart diseases(CHDs).The technique remains challenging and can only be performed in a fe...Background:Intrauterine valvuloplasty is an innovative therapy,which promotes ventricular growth and function in some congenital heart diseases(CHDs).The technique remains challenging and can only be performed in a few centers.This study aimed to assess the feasibility and mid-term outcomes of fetal cardiac intervention(FCI)in fetuses with critical CHD in an experienced tertiary center.Methods:Five fetal aortic valvuloplasty(FAV)or fetal pulmonary valvuloplasty(FPV)procedures were performed in our fetal heart center between August 2018 and May 2022.Technical success was defined as crossing the aortic or pulmonary valve and balloon inflation,followed by evidence of increased blood flow across the valve and/or new regurgitation.Follow-up clinical records and echocardiography were obtained during the prenatal and postnatal periods.Results:Five fetuses received FAV or FPV,including critical aortic stenosis(n=2)and pulmonary atresia with intact ventricular septum(n=3).The mean maternal age was 33.0±2.6 years.The median gestational age(GA)at diagnosis was 24 weeks(range,22-26 weeks).The median GA at intervention was 29 weeks(range,28-32 weeks).All five cases underwent successful or partially successful procedures.One patient had pulmonary valve perforation without balloon dilation.No procedure-related deaths or significant complications occurred.However,one neonatal death occurred due to heart and renal failure.The median follow-up period was 29.5 months(range,8.0-48.0 months).The four surviving patients had achieved biventricular circulation,exhibited improved valve,and ventricular development at the last follow-up visit.Conclusion:Intrauterine FCI could be performed safely with good prognosis in critical CHD.展开更多
Objectives: This study is to introduce of the clinical experience of percutaneous mitral balloon valvuloplasty 350 cases in Chinese and the long term follow up. Method: The modfied Inoue method was performed. Results:...Objectives: This study is to introduce of the clinical experience of percutaneous mitral balloon valvuloplasty 350 cases in Chinese and the long term follow up. Method: The modfied Inoue method was performed. Results: Effective PBMV was performed in 344 cases, the success rate was 98.3%:mitral area assessed by 2 dimenrional echocardiography (1.11±0.29 to 2.19 ±0.40cm 2, P <0.01 ). One hundrad and five patients were followed at a mean (46.7± 26.3 ) months (range 9 months to 8.5 years). after procedure restenosis was 11.4%(12/15), death 2.9 %(3/105, cerebral embolism in 2, congestive heart failure in 1; mitral valve replacement in 3.8%(4/105). Conclusions: percutaneous mitral commissurotomy provided excellent immediate and lale clinical results.展开更多
Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous ...Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV). The ratios of balloon/valve were 0.95 ± 0.08 for 19 cases of typical AS and 1.00 ± 0.11 for 8 cases of hypoplastic AS. The patients were evaluated by the gradients across aotic valves in pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 (78.9％)cases of typical AS had a batter outcome and the gradient of the remaining 4 cases (26.7％) had increased after follow-up (△P ＞ 50 mm Hg) . Four of 8 (50.0％) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0％) rose. There was no moderate to severe aortic insufficiency (Al).Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and clinical improvement in pediatric patients. The outcome of PBAV for typical AS is better than for hypoplastic AS.展开更多
Background: Historically, the pathophysiology of Hiatal Hernias (HH) has not been fully understood. As a result, the surgical therapy of HH has focused primarily on gastrointestinal symptoms and Gastroesophageal Reflu...Background: Historically, the pathophysiology of Hiatal Hernias (HH) has not been fully understood. As a result, the surgical therapy of HH has focused primarily on gastrointestinal symptoms and Gastroesophageal Reflux (GERD). This treatment strategy has been associated with poor relief of symptoms and poor long-term outcomes. In fact, until recently, most patients with HH have been watched and referred for surgery as a last resort. Recent experience has shown that a large (giant) Hiatal Hernia (GHH) is a common problem known to impact adjacent organs such as the hearts and lungs. Those referred for surgical repair often complain of dyspnea, which is erroneously attributed to pulmonary compression or aspiration, but has been shown to be from tamponade caused from compression of the heart by herniated abdominal contents. This article reviews the present understanding of GHH, the cardiac complications which result from GHH, and the most advanced robotic minimally invasive surgical approach to the anatomic and physiologic repair of GHH. Methods: In a prospective cohort study, we evaluated patients undergoing RRHH with at least a 2-year follow-up. All patients undergoing elective (RRHH) were identified preoperatively and enrolled prospectively in this study. Preoperative characteristics, medical comorbidities, and clinical information were all recorded prospectively and recorded into a secure surgical outcomes database. All patients received the previously validated Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire preoperatively and at postoperative time points of 1 month, 1 year, and 2 years. Patients routinely had a barium swallow postoperatively before discharge but did not undergo a barium swallow, an endoscopy, or a CT scan study at the 1-month time point unless indicated by symptoms. At 6 months, 1 year, and yearly intervals thereafter, all patients received an endoscopy study to ascertain the presence of a recurrence, regardless of symptoms. Recurrence was defined as ove展开更多
Objective To evaluate the therapeutic effects of external valvuloplasty technique in deep venous valve insufficiency of the lower limbs Methods External valvuloplasty of the femoral vein valve was perf...Objective To evaluate the therapeutic effects of external valvuloplasty technique in deep venous valve insufficiency of the lower limbs Methods External valvuloplasty of the femoral vein valve was performed in 30 patients(41 limbs) with deep venous valve insufficiency of the lower limbs The patients ranged in age from 16 to 69 years (±s , 50 8±9 2) External valvuloplasty of the first pair of superficial femoral vein valve was carried out in all limbs External valvuloplasty of the second pair of superficial femoral vein valve was added in 7 limbs and valvuloplasty of the common femoral vein valve in 6 limbs Results Venous claudication, swelling, aching disappeared in 78 0% limbs (32), obvious improvement was seen in 22 0% (9), and varicosis disappeared in all limbs Ulcer healing was observed in 80% (8/10) limbs Deep venous valve sufficiency was shown in 90 2% limbs, and reflux Ⅰ°-Ⅱ° in 4 by color Doppler Conclusion External valvuloplasty is an effective method to treat deep venous valve insufficiency of the lower limbs展开更多
Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdo...Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdong cardiovascular institute between February 2001 and August 2002. Serial echocardiograms were performed in all patients at baseline, discharge and annually thereafter. Results Five-year follow-up rate was 97.1%. Five-year survival rate was 100%. Before and after PMMC and at follow-up, mean mitral valve area by two-dimensional echocardiography was (0.87±0.15) cm2, (2.11±0.38) cm2 and (1.81±0.36) cm2, respectively (P<0.01). Five-year mitral restenosis rate was 6.1%. Conclusion PMMC can achieve excellent and sustained long-term results in selected patients with mitral echocardiographic score exceeding or being equal to 9.展开更多
目的:探讨室间隔缺损(VSD)修补术后中远期主动脉瓣关闭不全(AI)的外科治疗方法。方法:总结1996-01至2007-12我院22例VSD术后AI的外科治疗经验。主动脉瓣病变以穿孔为主,本组主动脉瓣置换13例,主动脉瓣成形9例。结果:22例患者中手术死亡...目的:探讨室间隔缺损(VSD)修补术后中远期主动脉瓣关闭不全(AI)的外科治疗方法。方法:总结1996-01至2007-12我院22例VSD术后AI的外科治疗经验。主动脉瓣病变以穿孔为主,本组主动脉瓣置换13例,主动脉瓣成形9例。结果:22例患者中手术死亡1例。出院检查与术前比,心胸比率(0.52±0.04 vs 0.57±0.07,P<0.05)及左心室舒张末径[(46.7±5.8)mm vs(54.5±10.2)mm,P<0.05]均有明显缩小,差异有统计学意义。超声心动图检查3例患者主动脉瓣少量反流,余未见明显异常。结论:本病的主要原因可能为手术损伤造成,外科治疗效果满意。展开更多
BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This...BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.展开更多
文摘Background： Percutaneous balloon pulmonary valvuloplasty （PBPV） is the preferred therapy for pulmonary valve stenosis （PVS）. This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim of this study was to evaluate factors associated with immediate therapeutic outcomes and restenosis during medium-term follow-up. Methods： The study included 158 infants with PVS who underwent PBPV from January 2009 to July 2015. Demographic characteristics and patient records were reviewed, including detailed hospitalization parameters, hemodynamic data before and immediately after balloon dilation, cineangiograms,and echocardiograms before PBPV and at each follow-up.All procedures were performed by more than two experienced operators. Results： Immediately after balloon dilation, the pressure gradient across the pulmonary valve decreased from 73.09 ± 21.89 mmHg （range： 43-151 mmHg） to 24.49 ± 17.00 mmHg （range： 3-92 mmHg; P 〈 0.001） and the right ventricular systolic pressure decreased from 95.34 ± 23.44 mmHg （range： 60-174 mmHg） to 52.07 ± 18.89 mmHg （range： 22-134 mmHg; P 〈 0.001）. Residual transvalvular pressure gradientsof67.31±15.19mmHg（range：50-92mmHg）werefoundin8.2%ofpatients,indicatingpoortherapeuticeffects;6.4%ofpatientshad variable-staged restenosis at follow-up and 3.8% underwent reintervention by balloon dilation or surgical repairs. Further analysis demonstrated that the balloon/annulus ratio showed statistically significant differences（P 〈 0.05） among groups with different therapeutic effects and between the restenosis and no-stenosis groups. Binary logistic regression analysis further revealed that higher balloon/annulus ratio （odds ratio： 0.005, 95% confidence interval： 0-0.39） was an independent protective factor for restenosis. The rate of severe complications was 1.9%. Conclusions： PBPV is a definitive therapy for infants with PVS based on its effectiveness, feasibility, and safety. Restenosis upon medium-term follow-u
文摘Background： Tricuspid regurgitation （TR） is frequently associated with severe mitral stenosis （MS）, the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty （PBMV） procedure in rheumatic heart disease patients with mitral valve （MV） stenosis and tricuspid valve regurgitation. Methods： Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV： MV area （MVA）, TR area （TRA）, atrial pressure and diameter, and pulmonary artery pressure （PAP）. The patients were followed for 6 months to 9 years. Results： After PBMV, the MVAs increased significantly （1.7 ± 0.3 cm2 vs. 0.9 ± 0.3 cm2, P 〈 0.01）; TRA significantly decreased （6.3 ± 1.7 cm2 vs. 14.2 ± 6.5 cm2, P 〈 0.01）, right atrial area （RAA） decreased significantly （21,5 ± 4.5 cm2 vs. 25.4 ± 4.3 cm〈 P 〈 0.05）, TRA/RAA （%） decreased significantly （29.3 ± 3.2% vs. 44.2 ± 3.6%, P 〈 0.01）. TR velocity （TRV） and TR continue time （TRT） as well as TRV - TRT decreased significantly （ 183.4± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P 〈 0.01 ; 185.7 ± 13.6 ms vs. 238.6 ±l 1.3 ms, P 〈 0.01 ; 34.2 ±5.6 cm vs. 60.7 ± 8.5 cm, P 〈 0.01, respectively）, The postoperative left atrial diameter （LAD） significantly reduced （41.3 ± 6.2 mm vs. 49.8± 6.8 mm, P 〈 0.01） and the postoperative right atrial diameter （RAD） significantly reduced （28.7 ±5.6 mm vs. 46.5 ± 6.3 mm, P 〈 0.01 ）; the postoperative left atrium pressure significantly reduced （ 15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P 〈 0.01 ）, the postoperative right atrial pressure decreased significantly （ 13.2 ±2.4 mmHg vs. 18.5 ±4.3 mmHg, P 〈 0.01 ）. The pulmonary arterial pressure d
文摘目的:评价改良迷宫术同期进行瓣膜手术的电生理效果及对心脏功能的远期影响。方法:24 例慢性房颤伴有二尖瓣疾病施行改良迷宫和二尖瓣手术的患者进行12导联心电图、心内电生理、动态心电图和超声心动图检查,平均随访(92.7±11.9)个月。结果:(1)术后3个月90%恢复窦性心律,术后1年以上100%恢复窦性心律。(2)除1例Ⅰ度房室传导阻滞外,窦房结及房室结功能检查均正常。(3)除高位右房外心房各部位有效不应期均显著延长,在心房各部位猝发和程控刺激均不能诱发房扑和房颤。(4)电生理检查有正常的心房激动和房室同步顺序。(5)动态心电图显示有良好的心率变时性反应和运动耐力。(6)随访期中再住院率为4%。(7)超声心动图显示随访期左房长径较术后明显减小[(5.52±1.22) cm vs (6.77±1.36) cm, P<0.01];随访期左房容积明显小于术后[(91.97±52.64) cm3vs(155.35±88.86) cm3, P<0.001];随访期右房长径明显小于术后[(4.72±0.85) cm vs (5.77±1.18) cm,P<0.05]。(8)左心室收缩功能正常,平均EF值为(56.00±19.75)%,平均FS值为(32.86±9.53)%。结论:在改良迷宫同时进行瓣膜手术均能安全有效的消除房颤维持窦律减小心房容积,恢复正常的房室同步传导和左心功能。
基金supported by grants from the Shanghai Municipal Health Commission Scientific Research Projects(Nos.202040160 and 20214Y0126)the National Natural Science Foundation of China(Nos.82071936 and 82270311)
文摘Background:Intrauterine valvuloplasty is an innovative therapy,which promotes ventricular growth and function in some congenital heart diseases(CHDs).The technique remains challenging and can only be performed in a few centers.This study aimed to assess the feasibility and mid-term outcomes of fetal cardiac intervention(FCI)in fetuses with critical CHD in an experienced tertiary center.Methods:Five fetal aortic valvuloplasty(FAV)or fetal pulmonary valvuloplasty(FPV)procedures were performed in our fetal heart center between August 2018 and May 2022.Technical success was defined as crossing the aortic or pulmonary valve and balloon inflation,followed by evidence of increased blood flow across the valve and/or new regurgitation.Follow-up clinical records and echocardiography were obtained during the prenatal and postnatal periods.Results:Five fetuses received FAV or FPV,including critical aortic stenosis(n=2)and pulmonary atresia with intact ventricular septum(n=3).The mean maternal age was 33.0±2.6 years.The median gestational age(GA)at diagnosis was 24 weeks(range,22-26 weeks).The median GA at intervention was 29 weeks(range,28-32 weeks).All five cases underwent successful or partially successful procedures.One patient had pulmonary valve perforation without balloon dilation.No procedure-related deaths or significant complications occurred.However,one neonatal death occurred due to heart and renal failure.The median follow-up period was 29.5 months(range,8.0-48.0 months).The four surviving patients had achieved biventricular circulation,exhibited improved valve,and ventricular development at the last follow-up visit.Conclusion:Intrauterine FCI could be performed safely with good prognosis in critical CHD.
文摘Objectives: This study is to introduce of the clinical experience of percutaneous mitral balloon valvuloplasty 350 cases in Chinese and the long term follow up. Method: The modfied Inoue method was performed. Results: Effective PBMV was performed in 344 cases, the success rate was 98.3%:mitral area assessed by 2 dimenrional echocardiography (1.11±0.29 to 2.19 ±0.40cm 2, P <0.01 ). One hundrad and five patients were followed at a mean (46.7± 26.3 ) months (range 9 months to 8.5 years). after procedure restenosis was 11.4%(12/15), death 2.9 %(3/105, cerebral embolism in 2, congestive heart failure in 1; mitral valve replacement in 3.8%(4/105). Conclusions: percutaneous mitral commissurotomy provided excellent immediate and lale clinical results.
文摘Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV). The ratios of balloon/valve were 0.95 ± 0.08 for 19 cases of typical AS and 1.00 ± 0.11 for 8 cases of hypoplastic AS. The patients were evaluated by the gradients across aotic valves in pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 (78.9％)cases of typical AS had a batter outcome and the gradient of the remaining 4 cases (26.7％) had increased after follow-up (△P ＞ 50 mm Hg) . Four of 8 (50.0％) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0％) rose. There was no moderate to severe aortic insufficiency (Al).Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and clinical improvement in pediatric patients. The outcome of PBAV for typical AS is better than for hypoplastic AS.
文摘Background: Historically, the pathophysiology of Hiatal Hernias (HH) has not been fully understood. As a result, the surgical therapy of HH has focused primarily on gastrointestinal symptoms and Gastroesophageal Reflux (GERD). This treatment strategy has been associated with poor relief of symptoms and poor long-term outcomes. In fact, until recently, most patients with HH have been watched and referred for surgery as a last resort. Recent experience has shown that a large (giant) Hiatal Hernia (GHH) is a common problem known to impact adjacent organs such as the hearts and lungs. Those referred for surgical repair often complain of dyspnea, which is erroneously attributed to pulmonary compression or aspiration, but has been shown to be from tamponade caused from compression of the heart by herniated abdominal contents. This article reviews the present understanding of GHH, the cardiac complications which result from GHH, and the most advanced robotic minimally invasive surgical approach to the anatomic and physiologic repair of GHH. Methods: In a prospective cohort study, we evaluated patients undergoing RRHH with at least a 2-year follow-up. All patients undergoing elective (RRHH) were identified preoperatively and enrolled prospectively in this study. Preoperative characteristics, medical comorbidities, and clinical information were all recorded prospectively and recorded into a secure surgical outcomes database. All patients received the previously validated Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire preoperatively and at postoperative time points of 1 month, 1 year, and 2 years. Patients routinely had a barium swallow postoperatively before discharge but did not undergo a barium swallow, an endoscopy, or a CT scan study at the 1-month time point unless indicated by symptoms. At 6 months, 1 year, and yearly intervals thereafter, all patients received an endoscopy study to ascertain the presence of a recurrence, regardless of symptoms. Recurrence was defined as ove
文摘Objective To evaluate the therapeutic effects of external valvuloplasty technique in deep venous valve insufficiency of the lower limbs Methods External valvuloplasty of the femoral vein valve was performed in 30 patients(41 limbs) with deep venous valve insufficiency of the lower limbs The patients ranged in age from 16 to 69 years (±s , 50 8±9 2) External valvuloplasty of the first pair of superficial femoral vein valve was carried out in all limbs External valvuloplasty of the second pair of superficial femoral vein valve was added in 7 limbs and valvuloplasty of the common femoral vein valve in 6 limbs Results Venous claudication, swelling, aching disappeared in 78 0% limbs (32), obvious improvement was seen in 22 0% (9), and varicosis disappeared in all limbs Ulcer healing was observed in 80% (8/10) limbs Deep venous valve sufficiency was shown in 90 2% limbs, and reflux Ⅰ°-Ⅱ° in 4 by color Doppler Conclusion External valvuloplasty is an effective method to treat deep venous valve insufficiency of the lower limbs
文摘Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdong cardiovascular institute between February 2001 and August 2002. Serial echocardiograms were performed in all patients at baseline, discharge and annually thereafter. Results Five-year follow-up rate was 97.1%. Five-year survival rate was 100%. Before and after PMMC and at follow-up, mean mitral valve area by two-dimensional echocardiography was (0.87±0.15) cm2, (2.11±0.38) cm2 and (1.81±0.36) cm2, respectively (P<0.01). Five-year mitral restenosis rate was 6.1%. Conclusion PMMC can achieve excellent and sustained long-term results in selected patients with mitral echocardiographic score exceeding or being equal to 9.
文摘目的:探讨室间隔缺损(VSD)修补术后中远期主动脉瓣关闭不全(AI)的外科治疗方法。方法:总结1996-01至2007-12我院22例VSD术后AI的外科治疗经验。主动脉瓣病变以穿孔为主,本组主动脉瓣置换13例,主动脉瓣成形9例。结果:22例患者中手术死亡1例。出院检查与术前比,心胸比率(0.52±0.04 vs 0.57±0.07,P<0.05)及左心室舒张末径[(46.7±5.8)mm vs(54.5±10.2)mm,P<0.05]均有明显缩小,差异有统计学意义。超声心动图检查3例患者主动脉瓣少量反流,余未见明显异常。结论:本病的主要原因可能为手术损伤造成,外科治疗效果满意。
基金supported by National Key R & D Plan(2017YFC1104202).
文摘BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.
