Objective To evaluate the surgical effects of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins stripping on primary deep venous valvular incompetence of the lower limb.Methods Seventy-eight patients (92 limbs) with primary deep venous valvular incompetence of the lower limbs received the operations of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins from 1997 to 2004. There were 65 males and 13 females, and their ages ranged from 32 years to 72 years (mean age of 52.5 years). The valvular reflux grades of these 92 limbs varied from Ⅲ to Ⅳ according to Kistner’s standard. A sleeve made from the stripped great saphenous vein was used in the indirect loop valvuloplasty of the superficial femoral vein. The early results of surgery were retrospectively analyzed. Results Pre-operative symptoms, such as edema, ulceration, pigmentation and heavy feeling of the performed limbs disappeared or were remarkably improved in 65 cases (76 limbs) after operation. Eight cases (10 limbs) had alleviative symptoms compared with pre-operative ones. Meanwhile, no improvement of symptoms was observed in 3 patients (4 limbs). Acute ilio-femoral vein thrombosis occurred in 2 patients (2 limbs), which manifested as more servious edema of the lower limbs than those before operation. The overall effective rate of surgery was 93.5%（86/92）, and the complications rate was 2.2% (2/92). Conclusion Indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose vein stripping is an effective and convenient way to correct the primary deep venous valvular incompetence of the lower limb. The surgical indications of this disease should be emphasized strictly to assure the good outcomes.
Objective To evaluate the surgical characteristics, methods and clinical effect of pediatric valvoplasty through an analysis of valvoplasty in children in the age from 15 h to 14 years. Methods From January 1993 to June 2003, 376 children underwent valvoplasty. There were 349 cases (92.8%) of congenital heart disease and 27 cases(7.2%) of acquired heart disease. The procedure included mitral valvoplasty in 79 (19.4%), tricuspid valvoplasty in 159 (39.1%), aortic valvoplasty in 40 (9.8%), and pulmonary valvoplasty in 129(31.7%). Results There were 12 early deaths (3.2%) after the procedure. 297 patients were followed up from 1 month to 10 years (mean, 4.9±2.4 years). There were 2 late deaths (0.7%) after discharge. There were 5 cases (1.7%) of re-operation due to valve problem. Conclusions Valvoplasty should be the first choice in dealing with valve diseases in children. The effect of the valvoplasty works on the prognosis of the operation.
The clinical results of one-staged indirect valvuloplasty of the superficial femoral vein by wrapping an autogenous saphanous vein cuff to treat 20 patients with primary valvular incompetence of deep vein. The results following postoperative follow-up were 16 patients ahd striking improvement, excellent improvement in 2. venuos thrombosis in 1 and one failure. The operative procedure was introduced, the indications for operation was discussed, and the results were vealuated.
目的总结左心功能低下的冠心病合并瓣膜病变26例患者的外科治疗效果及经验体会。 方法回顾性分析2009年1月至2013年6月福建省立医院左心功能低下（左心室射血分数＜50%）的冠状动脉旁路移植术+瓣膜置换或成形术26例患者的临床资料，其中男15例、女11例，年龄52～72（65.3±8.7）岁。 结果全组均痊愈出院。体外循环时间（156.6±29.4）min，升主动脉阻断时间（76.2±28.8）min，术后呼吸机辅助时间（80.8±22.8）h，住ICU时间（5.6±2.8）d，术后住院时间（18.6±9.3）d，术后血管活性药物应用时间（7.1±1.9）d，全组未使用主动脉内球囊反搏及心脏辅助装置，术后7 d复查心脏彩超，左心室射血分数［45.5%±3.3%（42%～49%）］与术前差异无统计学意义（P＞0.05），左心室舒张期末内径（LVEDD）［（5.1±1.2）］ cm与术前差异有统计学意义（P＜0.05）。 结论左心功能低下的冠心病合并瓣膜病变非手术禁忌，行冠状动脉旁路移植术加瓣膜手术可以取得良好手术疗效。
Abstract: Objective To summarize the clinical results of homemade flexible annuloplasty ring in mitral valve repair, in order to discuss the appropriate ring size. Methods Sixtysix patients (55 males,and 11 females with a mean age of 44.62±15.94 years) with mitral insufficiency underwent mitral valve repair with homemade flexible annuloplasty ring from April 2002 to November 2009 in Fu Wai Hospital. In order to choose the ring with an appropriate size, we made and kept to the following principles: if the intercommissural distance was bigger than size 30, we chose a ring 2size smaller; if the measured distance was smaller than size 30, 1size smaller ring would be chosen. Patients were followed by echocardiography to observe the mitral valve function. Results All patients were cured and discharged from the hospital. The results of echocardiography showed mild to moderate regurgitation in 1 patient, mild regurgitation in 11 patients, and normal mitral function or trace regurgitation in the rest 54 patients. Mitral valve forward velocity was 1.40±0.30 m/s with no mitral stenosis or systolic anterior motion (SAM) of the anterior mitral leaflet. Fiftyone patients were followed up from 2 months to 7 years(24.60±25.90 months). The results of echocardiography on 38 patients showed that 1 patient had moderate regurgitation, 5 patients had mild to moderate regurgitation, 9 patients had mild regurgitation and others had normal mitral function or trace regurgitation. For these 38 patients included in the followup study, mitral valve forward velocity was 1.50±0.40 m/s with no mitral stenosis, SAM or left ventricular outlet tract obstruction. During the followup, the left atrium size (43.19±10.48 mm vs. 48.59±9.40 mm, t=4.524, P=0.000) and left ventricular end diastolic diameter (52.64±7.35 mm vs. 6269±8.77 mm, t=7.607, P=0.000) decreased significantly than the preoperative size and diameter respectively. The application of restrictive homemade flexible annuloplasty ring in mitral valve annuloplasty had satisfactory, durable and stable clinical results.
Objective To analyze the early prognosis of repairing adult aortic insufficiency with the Florida sleeve procedure. Methods The patients with aortic insufficiency who underwent Florida sleeve repair in the Nanjing First Hospital, Nanjing Medical University between August 2020 and May 2024 were selected. Their general data, perioperative conditions, and echocardiographic data before, during, and after the procedure and at follow-up were analyzed. Results Fifteen patients were included, consisting of 12 males and 3 females, aged 33-71 (53.5±12.4) years. Preoperative echocardiography indicated that there was 1 patient of rheumatic disease, 7 patients of degenerative disease, 4 patients secondary to aortic aneurysm, and 3 patients of bicuspid aortic valve. The severity distribution included 2 patients of severe insufficiency, 4 patients of moderate-to-severe insufficiency, 5 patients of moderate insufficiency, and 4 patients of mild-to-moderate insufficiency. The mean cardiopulmonary bypass time was (135.0±40.0) minutes, the aortic cross-clamp time was (109.9±38.6) minutes, and the median ICU stay was 1.0 day. No mortality was recorded within 30 days postoperatively. Follow-up echocardiography showed that the valve regurgitation, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and sinus diameter all achieved the desired outcomes. Conclusion Florida sleeve repair for aortic valve in patients with a sinus diameter less than 50 mm not only effectively improves hemodynamics in adults with aortic insufficiency, but also has the advantages of low surgical risk and rapid postoperative recovery, making it a promising procedure for clinical application.
目的 探讨四维经食管超声心动图（4D-TEE）在瓣膜修复中的作用。 方法 2016 年 1 月我院对 3 例行二尖瓣修复和 1 例行主动脉瓣膜修复的患者采用西门子 SC2000 4D-TEE 进行术前术后评估，其中男 2 例、女 2 例，年龄38～59 （48.0±10.5）岁。同期采用二维经食管超声心动图指导二尖瓣和主动脉瓣修复的 13 例患者作为对照，其中男 8 例、女 5 例，年龄43～67（56.4±7.5）岁。 结果 术中 4D-TEE 可实时显示瓣叶的各项参数，如不同节段瓣叶高度、交界区面积、瓣叶面积、对合面的大小、窦管交界大小，瓣膜运动形态、主动脉管壁位移等信息。可根据内置软件建立个性化的瓣膜几何模型，动态模拟瓣膜启闭并直观呈现。对照组仅可显示某切面的瓣膜、腱索、乳头肌、心腔等信息。 结论 4D-TEE 跳过了对二维图像的解读步骤，更直观完整地显示了瓣膜形态和动态，可以通过它的辅助来进行更有效的手术决策。
ObjectiveTo investigate the prognosis and risk factors of mild to moderate or moderate atrioventricular valve regurgitation (AVVR) after Fontan operation.MethodsA total of 34 patients with mild to moderate or moderate AVVR who accepted Fontan operation and atrioventricular valve (AVV) repair between 2004 and 2018 in our center were selected as an AVV repair group. The patients in the same period were matched as a control group by the ratio of 1 : 1-2. Finally 99 patients were included into this study, including 64 males and 35 females, with an average age of 63.4±36.3 months and weight of 17.3±6.7 kg. Grades of AVVR decreased more than 1 was defined as significant improvement. Endpoints of the study were death, Fontan takedown, AVV replacement. Risk factors including Fontan procedures, AVV repair procedures, cardiac anatomy were analyzed.ResultsPatients were followed up for 1.5 (0.3-4.0) years. Overall mortality was 15.2%. Most (82.4%) of AVV repair group accepted single AVV repair procedure while partial annuloplasty was the most common (52.9%). With the extension of follow-up, the degree of AVVR in the whole group showed a gradually increasing trend (r=0.352, P=0.000). Mild to moderate AVVR improved spontaneously after Fontan operation, while moderate AVVR did not. AVV repair could improve the degree of AVVR after moderate regurgitation, without increasing the surgical mortality, and regurgitation significantly decreased in 8.8% patients. AVV repair was not effective for mild to moderate AVVR and would increase surgical mortality. ConclusionAVV function shows a gradual downward trend after Fontan operation. AVV repair is effective for moderate AVVR, does not increase mortality, but the degree of improvement is limited. AVV repair is not effective for mild to moderate AVVR and increases surgical mortality.