Preoperative evaluation is crucial for heart valvular surgery. This article discusses some issues that need to be emphasized: the impact of hypertension on the severity of aortic valve lesions, and how to improve the accuracy of clinical assessment; the identification of functional tricuspid regurgitation, in order to choose the appropriate surgical technique; the need for right ventricular function testing, and the use of risk scoring models, to better grasp surgical timing and indications and improve efficacy; and the importance of evaluating atrial mitral and/or tricuspid regurgitation complications in chronic atrial fibrillation, and making rational choices for interventional and surgical treatment.
Early enteral nutrition after cardiopulmonary bypass (CPB) has been shown to have beneficial effects on intestinal integrity, lower mortality and also on the patient’s immunocompetence. Even in critical patients after CPB, enteral nutrition should be reasonable to start early and also be supplemented by parenteral nutrition in order to meet energy requirement. We conclude that enteral nutrition is preferable in the majority of patients with severe hemodynamic failure, but gastrointestinal complication and hypocaloric feeding should be simultaneously noticed. This paper comprehensively described enteral nutrition’s protective mechanism and effects on digestive system, enteral nutrition’s implementing methods after CPB, and problems or prospects needing attention in execution.
Abstract： Quality of life （QOL） refers to an individual’s perception and subjective evaluation of their health and well-being, and has become an important index to evaluate the outcomes of clinical treatment in the last past decades. There are a large number of different instruments to evaluate QOL, and the 36-Item Short Form Health Survey （SF-36） is currently one of the most widely used instruments. In recent years, SF-36 has been used to evaluate QOL of valvular heart disease patients to investigate the risk factors those influence their postoperative QOL, provide more preoperative evaluation tools for clinical physicians, and improve postoperative outcomes of patients with valvular heart disease. However, it is now just the beginning to use SF-36 to examine QOL of valvular heart disease patients. Because of significant differences in sample size, follow-up period, country and culture, current research has some controversial results. This review focuses on the progress in evaluating QOL in postoperative patients with valvular heart disease using SF-36.
Objective To improve the surgical results of infective endocarditis, the results and methods of aortic root replacement in patients with severe aortic valve infective or prosthetic valve endocarditis were summarized. Methods From Sept.1995 to June 2008, there were 11 patients with severe aortic valve endocarditis treated surgically, included 6 active endocarditis and 5 healed endocarditis. Preoperative arterial blood bacterial culture were positive in 6 patients. Preoperative echocardiography showed all patients had various degree of aortic regurgitation or paraprosthetic leakage, left ventricular endsystolic diameter(LVESD) was 6.0±0.7cm, LVESD was equal or greater than 5.5cm in 7 patients, left ventricular ejection fraction (LVEF) was 47.8%±11.2％, and LVEF was equal or less than 50% in 8 patients. After careful debridement, composite conduit (9 patients) or cryopreserved allograft (2 patients) was used to replace the aortic root. Concomitant procedures were coronary artery bypass grafting in 4 patients, mitral annuloplasty in 3 patients, and ventricular septal defect repair in 1 patient. Results There was one patient died of postoperative cardiac arrest, one patient had Ⅲ° atrioventricular block and pacemaker implanted. Ten patients were followed up, followup time were from 3 months to 13.2 years. During the followup period, one patient had recurrence of endocarditis and died, others survived uneventually. Conclusion Aortic root replacement must be considered in following patients: endocarditis combined with root aneurysm or sinus aneurysm, infectious disease involved in sinus wall or nearby coronary ostia, annulus impairment and severe destructive annulus after debridement. The key points of the surgery are debriding the infectious tissue completely, preventing aortic root bleeding. Although the root replacement is relatively complex, the surgical results could be improved after complete debridement of infectious tissue.
Abstract： Objective To summarize the methods and results of supra-annular aortic valve replacement（AVR） in patients with severely damaged aortic annulus. Methods Supra-annular AVR was performed in 5 patients between March 2008 and Dec. 2010 in Changhai Hospital, Second Military Medical University. There were 4 males and 1 female with their mean age of 46.3 years (ranging from 38 to 53 years). Non-specific infectious diseases were diagnosed in 4 patients who had severe paravalvular leakage after their first AVR operations (2 patients with Behcet’s disease and 2 patients with arteritis), and one patient had severe infectious endocarditis. All the patients had severely destroyed aortic annulus and could not undergo routine AVR. The prosthetic valves were fixed to the aortic sinus wall between the annulus and coronary arterial ostia, and the sutures passed through from the outside of aortic wall into the inside and prosthetic valve ring. Coronary artery bypass grafting was performed if the coronary ostium was involved. Results All patients recovered from the operations uneventfully, and were followed up from 6 months to 3 years. All patients were in New York Heart Association（NYHA） functional class Ⅰ or Ⅱ during the follow-up period, and paravalvalar leakage, pseudoaneurysm and aortic root aneurysm were not found by the examination of 3D computed tomographic angiography and echocardiography at 6 months（4 cases）, 1 year（2 cases）, and 3 years（1 case）, respectively . Conclusions Supra-annular AVR is an alternative surgical method for patients with severely damaged aortic annulus. The procedure is simple and effective to prevent paravalvular leakage and pseudoaneurysm formation.
Abstract:Objective To summarize the experiences in surgical treatment of ascending aortic root aneurysms. Methods One hundred and one patients （age ranging from 14 to 72 years, mean 42.7 years） with ascending aortic root aneurysms were diagnosed as having Marfan syndrome （58 cases）, annuloaortic ectasia （34 cases）, bicuspid aortic valve （5 cases）, aorto arteritis （4 cases） combined with aortic valve incompetence （96 cases） and aortic valve stenosis （4 cases） , preoperatively with type A dissection （26 cases） and acute left heart failure （5 cases）. Our operations consisted of 4 Wheat procedures, 13 Cabrol or modified Cabrol procedures, 1 David and 83 Bentall procedures. Concomitant operations included hemi-arch replacement or descending aorta intraluminal stent grafting （16 cases）, total arch replacement or descending aorta intraluminal stent grafting （4 cases）, mitral valve replacement or anuloplasty （14 cases） and coronary artery bypass grafting （CABG, 8 cases）. Results The overall mortality was 6.9%（7/101）, and decreased to 3. 6%（3/83） after the year 2000. Main postoperative complications were low cardiac output （10 cases）, respiratory insufficiency （9 cases）, and renal inadequacy （9 cases）. Follow-up was completed in 94 patients. During the period of follow-up, one patient died and 5 patients with Marfan syndrome suffered with type B dissection. Conclusion Bentall procedure is the method of choice for ascending aortic root aneurysms. Preoperative left heart function and surgical techniques give the crucial impact on the outcome of surgery.
Abstract: Objective To evaluate the longterm results of surgical treatment of tetralogy of Fallot (TOF) in adults and discuss the perioperative treatment skills. Methods From January 2000 to March 2008, 149 patients older than 14 years with tetralogy of Fallot received surgical treatment in Changhai Hospital. Among the patients, there were 78 males and 71 females with ages ranged from 14 years to 53 years and the average age was 26.3 years. Twenty patients had previous pulmonary arterial shunts before radical treatment. A total of 129 patients underwent primary radical treatment. Thirtyeight patients received a right ventricular outflow tract patch, 107 patients had transannular patch, and 4 patients had homograft aorta with valves. Results Hospital mortality was 4.0%(6/149). Four patients died of low cardiac output syndrome (LCOS), and multiple organ failure, and 2 patients died of acute renal failure. The postoperative complications included pleural effusion in 11 patients, pulmonary edema in 10 patients, severe LCOS in 9 patients, severe cardiac arrhythmia in 7 patients, reoperation for excessive bleeding in 7 patients, reintubation in 6 patients, and residual ventricular septal defect (VSD) in 5 patients (two of them had reoperation for residual VSD repair and 2 received transcatheter closure of VSD). One hundred and thirtyfour patients were followed up for 3 to 102 months (47.2±28.6 months) with a followup rate of 93.7%(134/143). Late death occurred in 2 patients, one of whom died of secondary infective endocarditis and the other had a sudden death 29 months after operation. During the followup, one patient had residual VSD (2 mm), but had a normal life. The peak systolic right ventricletopulmonary artery pressure gradient exceeded 40 mmHg in 4 patients. Two patients had severe pulmonary regurgitation. A total of 132 patients survived and had an improved life. One hundred and twentyone patients had class Ⅰ heart function (NYHA), and 11 patients in class Ⅱ. Conclusion The pathophysiologic conditions of the patients with tetralogy of Fallot in adults are very complicated due to longterm right ventricle outlet stricture and chronic hypoxia. Preoperative evaluations and postoperative treatment of complications are necessary. The systemicpulmonary arterial shunts should be performed when hypotrophy of the pulmonary arteries or left ventricles exists. Repair of tetralogy of Fallot in adults has acceptable morbidity and mortality rates with goodlongterm outcomes.