ObjectiveTo investigate the feasibility and safety of transcatheter aortic valve replacement (TAVR) through apical approach for aortic regurgitation of large annulus.MethodsFrom November 2019 to May 2020, 10 male patients aged 64.50±4.20 years with aortic valve insufficiency (AI) underwent TAVR in the Department of Cardiovascular Surgery, Xijing Hospital. The surgical instruments were 29# J-valveTM modified and the patients underwent TAVR under angiography. The preoperative and postoperative cardiac function, valve regurgitation, complications and left ventricular remodeling were summarized by ultrasound and CT before and after TAVR.ResultsA total of 10 valves were implanted in 10 patients. Among them, 1 patient was transferred to the aortic arch during the operation and was transferred to surgical aortic valve replacement; the other 9 patients were successfully implanted with J-valve, with 6 patients of cardiac function (NYHA) class Ⅱ, 4 patients of grade Ⅲ. And there was a significant difference between preoperation and postoperation in left ventricular ejection fraction (44.70%±8.78% vs. 39.80%±8.48%, P<0.05) or aortic regurgitation (1.75±0.72 mL vs. 16.51±8.71 mL, P<0.05). After 3 months, the patients' cardiac function was good.ConclusionTAVR is safe and effective in the treatment of severe valvular disease with AI using J-valve.
Eighteen cases of primary incompetence of the valves of the deep veins of leg were treated by various types of operations were reported. The patients were followed up for 4 to 26 months, with complete disappearance of symptoms and marked improvement of the concomittant dermatitis. The ulcerative lesions were healed within 1 to 3 weeks after operation. Three patients received postoperative vcnography with retrograde vcnography, the results showed that the valves had first degree function.
Transcatheter aortic valve replacement (TAVR) has entered a new and critical stage after nearly 20 years of rapid development in China. There are various types of TAVR valves with different advantages. TAVR can be performed through various approaches such as transfemoral artery, transapical, trans-carotid artery, or trans-ascending aorta. The first two are more common. Echocardiography plays an important role in the perioperative period of TAVR. Compared to transfemoral approach, transapical TAVR has different key points in perioperative echocardiography which is lack of unified and accurate standards. This standard is specially formulated to focus on the key points of echocardiography in preoperative screening, intraoperative monitoring and postoperative follow-up in order to promote the safe and effective application of transapical TAVR in the clinic.
Heart valve disease (HVD) is one of the common cardiovascular diseases. Heart sound is an important physiological signal for diagnosing HVDs. This paper proposed a model based on combination of basic component features and envelope autocorrelation features to detect early HVDs. Initially, heart sound signals lasting 5 minutes were denoised by empirical mode decomposition (EMD) algorithm and segmented. Then the basic component features and envelope autocorrelation features of heart sound segments were extracted to construct heart sound feature set. Then the max-relevance and min-redundancy (MRMR) algorithm was utilized to select the optimal mixed feature subset. Finally, decision tree, support vector machine (SVM) and k-nearest neighbor (KNN) classifiers were trained to detect the early HVDs from the normal heart sounds and obtained the best accuracy of 99.9% in clinical database. Normal valve, abnormal semilunar valve and abnormal atrioventricular valve heart sounds were classified and the best accuracy was 99.8%. Moreover, normal valve, single-valve abnormal and multi-valve abnormal heart sounds were classified and the best accuracy was 98.2%. In public database, this method also obtained the good overall accuracy. The result demonstrated this proposed method had important value for the clinical diagnosis of early HVDs.
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.
ObjectiveTo systematically review the predictive factors of new-onset conduction abnormalities(NOCAs) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) patients. MethodsThe CNKI, VIP, WanFang Data, PubMed, Cochrane Library and EMbase databases were electronically searched to collect the relevant studies on NOCAs after TAVR in patients with BAV from inception to December 5, 2022. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsSix studies involving 758 patients with BAV were included. The results of the meta-analysis showed that age (MD=−1.48, 95%CI −2.73 to −0.23, P=0.02), chronic kidney disease (OR=0.14, 95%CI 0.06 to 0.34, P<0.01), preoperative left bundle branch block (LBBB) (OR=2.84, 95%CI 1.11 to 7.23, P=0.03), membranous septum length (MSL) (MD=0.93, 95%CI 0.05 to 1.80, P=0.04), implantation depth (ID) (MD=−2.06, 95%CI −2.96 to −1.16, P<0.01), the difference between MSL and ID (MD=3.05, 95%CI 1.92 to 4.18, P<0.01), and ID>MSL (OR=0.27, 95%CI 0.15 to 0.49, P<0.01) could be used as predictors of NOCAs. ConclusionCurrent evidence shows that age, chronic kidney disease, LBBB, MS, ID, the difference between MSL and ID, and ID>MSL could be used as predictors of NOCAs. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusion.
Abstract A new kind of soft tissue expander with exteriorized injection valve was reported. Two types of expanders were designed: one with single cyst, single tube and single chamber, and the other with single cyst, single tube but double chambers, i.e, an additional drainage chamber. The drainage orifice could be controlled by a valve. An animal experiment had been conducted, and the outcome suggested that the new expander could provide rapid expansion of the soft tissue, sufficient drainage of the expanded area. The bacterial culture showed that among the 42 samples obtained from the expanded cyst, only 3 were positive. (2 of bacteria and 1 of fungus), suggesting comparatively low cyst infection.
ObjectiveTo summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. MethodsFrom January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. ResultsA total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. ConclusionTranscatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.
ObjectiveTo systematically review the efficacy of MitraClip therapy in heart failure patients with mitral insufficiency. MethodsDatabases including PubMed, The Cochrane Library (Issue 11, 2014), EMbase, CBM, CNKI, VIP and WanFang Data were searched from October 2005 to October 2015 to collect before-after controlled studies about the efficacy of MitraClip therapy in heart failure patients with mitral insufficiency. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 9 studies involving 782 patients were included. The results of meta-analysis showed that, compared with their conditions before treatment, patients after the MitraClip implantation had a declined NYHA class Ⅲ-Ⅳ ratio (RD=0.72, 95%CI 0.60 to 0.85, P<0.000 01), increased left ventricular ejection fraction (LVEF) (MD=-2.97，95%CI -5.06 to -0.89，P<0.005) and improved performance in 6 min walk-test (6-MWT) (MD=-88.73, 95%CI -157.16 to -20.31, P=0.01). ConclusionMitraClip therapy can, to a certain extent, improve the cardiac function of patients with heart failure and mitral insufficiency. However, further studies are needed to confirm its effects on improving the long-term survival of patients.
The heart valve prosthesis must have excellent hydrodynamic performance which is usually tested in vitro, not in vivo. This paper comprehensively introduced the principles and methods of hydrodynamic performance in vitro testing, helping clinicians to understand valve performance parameters, evaluate valve applicability, and reduce clinical risk of the valve prosthesis. In vitro testing not only serves as the "gold standard" for valve prosthesis assessment, but also provides detailed data for design and optimization of the prosthesis. ISO 5840 defines the items and methods for valve in vitro testing, which consists of three parts: (1) pulsatile flow testing, which reproduces the pulsating flow of the valve prosthesis after implantation in the human body; (2) steady flow testing, which assesses valve forward flow resistance; (3) durability testing, which evaluates the durability of the valve prosthesis and determines the expected failure mode. In addition, the paper presented the differences between atrioventricular and aortic valve testing, the method of mitral valve testing, the differences between transcatheter and surgical valve testing, and the method of valve flow visualization.