ObjectiveTo explore the short-term efficacy and safety of Ozaki surgery in treating adult patients with aortic valve disease and to summarize clinical experience. MethodsClinical data of adult patients with aortic valve disease who underwent Ozaki surgery in the Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University Nanchong Branch in 2025 were collected, and the effectiveness and safety of Ozaki surgery were analyzed. ResultsA total of 5 patients were included, including 3 males and 2 females, with an average age of (47.80±12.99) years. One patient was aortic stenosis, 2 patients were aortic regurgitation, and 2 patients were aortic stenosis combined with regurgitation. Two patients underwent isolated Ozaki surgery, 1 patient underwent Ozaki+coronary artery bypass surgery, and 2 cases underwent Ozaki+mitral valve plasty+tricuspid valve plasty. The average operation time was (6.70±1.25) hours. The average extracorporeal circulation time was (217.20±59.47) minutes, the average aortic cross-clamping time was (153.60±45.71) minutes, the average postoperative ventilator support time was (25.00±11.79) hours, the average intensive care unit stay was (2.43±1.30) days, and the average postoperative hospital stay was (11.20±1.92) days. The postoperative average aortic valve flow rate was (1.70±0.26) m/s, and the average transvalve pressure gradient was (11.00±1.87) mm Hg. Postoperatively, 3 patients had no aortic regurgitation, and 2 patients had trace regurgitation. Postoperative complications included pulmonary infection in 3 patients, severe pneumonia in 1 patient, liver function damage in 4 patients, and renal function damage in 3 patients. No patients experienced arrhythmias or other complications. All 5 patients recovered and were discharged, and their cardiac function significantly improved postoperatively compared to preoperatively (P<0.001), with both left ventricle (P=0.047) and left atrium (P=0.016) reduced in size. ConclusionThe short-term results of Ozaki surgery for adult patients with aortic valve disease are satisfied, but long-term outcomes still need further exploration.
ObjectiveTo analyze the short-term clinical efficacy and prognosis of one-stop transcatheter aortic valve replacement (TAVR)+percutaneous coronary intervention (PCI) in the treatment of aortic valve disease with coronary heart disease. MethodsThe clinical data of patients with aortic valve disease complicated with coronary heart disease who underwent one-stop TAVR+PCI treatment at the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University from January 2018 to June 2023 were retrospective analyzed. The preoperative and postoperative clinical data were compared, and 1-month follow-up results were recorded. ResultsA total of 37 patients were enrolled, including 22 males and 15 females, with an average age of 69.14±6.47 years. Thirty-six patients recovered and were discharged after the surgery, and 1 (2.7%) patient died during the surgery. Self-expanding TAVR valves were implanted through the femoral artery in all patients. One coronary artery was opened by PCI in 35 (94.6%) patients, and two coronary arteries were opened by PCI in 2 (5.4%) patients. All PCI opened arteries had a stenosis>70%. During the postoperative hospitalization, the complications included pulmonary infection in 11 (30.6%) patients, severe pneumonia in 10 (27.8%) patients, liver function injury in 14 (38.9%) patients, renal function injury in 5 (13.9%) patients, cerebral infarction in 1 (2.8%) patient, atrial fibrillation in 1 (2.8%) patient, ventricular premature beats in 2 (5.6%) patients, atrioventricular block in 2 (5.6%) patients, and complete left bundle branch block in 5 (13.9%) patients. The median postoperative ventilation assistance time was 12.0 (0.0, 17.0) h, the ICU monitoring time was 1.0 (0.0, 2.0) d, and the postoperative hospitalization time was 5.0 (4.0, 7.0) d. There was a significant improvement in the New York Heart Association cardiac function grading after surgery (P<0.001). After surgery, there were 21 (58.3%) patients had minor perivalve leakage, 6 (16.7%) patients had minor to moderate perivalve leakage, and no moderate or above degree of perivalve leakage. After one month of postoperative follow-up, 36 patients showed significant improvement in heart function. There were no patients with recurrent acute coronary syndrome, re-PCI, or cardiovascular system disease related re-hospitalization. ConclusionThe one-stop TAVR+PCI treatment for patients with aortic valve disease and coronary heart disease can obtain satisfactory short-term clinical efficacy, which is worth further trying and studying.
Objective To evaluate the right ventricular function of the patients 2 years after surgery by ultrasonic cardiography (UCG) who underwent mitral valve replacement (MVR) concomitant tricuspid annuloplasty (TAP). Method We finally identified 36 patients required MVR with tricuspid valve annular dilation concomitant merely mild tricuspid regurgitaion (TR) based on preoperative UCG in our hospital between April and November 2012 year. All patients were randomly divided into two groups by digital table including a tricuspid annuloplasty group (a TAP group, n=18, 7 males and 11 females at age of 45.67±12.49 years) and a no-tricuspid annuloplasty group (a NTAP group, n=18, 6 males and 12 females at age of 45.44±10.48 years). General clinical data and extracorporeal circulation data were recorded. UCG evaluation was practiced preoperation, alone with 1 week, 6 months, and 2 years after surgery. Results Two years postoperative maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension-1(RVD1) , right ventricular fractional area change (RVFAC), 3D RV end-systolic volume (3DRVESV), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) of patients were all smaller in the TAP group than those in the NTAP group. Yet right ventricular ejection fraction (RVEF), percent shorting of tricuspid valve annulus (PSTVA) were greater in the TAP group than those in the NTAP group, although there was no statistical difference between the two groups in two years postoperative 3D RV end-diastolic volume (3DRVEDV). The patients in the TAP group had a superior trend than that of the NTAP group. Moreover, the patients' TR constituent ratio in the TAP group was much better than that of the NTAP group in 2 year after operation. Conclusions Concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR is favorable for the recovery of their 2 years postoperative function of tricuspid valve and right ventricle. It is benefit to reduce patient's long term postoperative TR residues and exacerbation.
Objective To evaluate the effectiveness of unsupported reduction ascending aortoplasty for dilatation of the ascending aorta. Methods Between September 2005 and May 2011, 53 patients with aortic valve disease and dilatation of the ascending aorta underwent aortic valve replacement with unsupported reduction ascending aortoplasty. There were 41males and 12 females, aged 22-75 years (mean, 52 years). The disease duration was 1 month to 14 years. The color Doppler echocardiography showed that the diameter of the ascending aorta before surgery was (45.9 ± 3.3) mm; bicuspid aortic valve and tri-aortic valve were observed in 13 and 40 cases respectively. The heart functions were graded as II level in 19 cases, III level in 33 cases, and IV level in 1 case according to the standard of New York Heart Disease Academy (NYHA). Results After operation, mediastinum errhysis occurred in 1 case, pneumonia in 3 cases, and III degree atrioventricular block in 1 case. There was no related complication of the aortoplasty. All the patients were followed up 3-68 months (mean, 15 months), and had no obvious chest tightness and palpitation. At last follow-up, the NYHA heart functions were graded as I level in 22 cases, II level in 31 cases; the diameter of the ascending aorta was (35.2 ± 4.0) mm, showing significant difference when compared with the preoperative one (P=0.000), but no significant difference when compared with the one at discharge (34.0 ± 2.5) mm (P=0.245). There was significant difference in the diameter of the ascending aorta between last follow-up and preoperation, at discharge in the patients who were followed up more than 60 months (P lt; 0.05); significant difference was found between last followup and preoperation in patients with bicuspid aortic valve (P lt; 0.05), but no significant difference between last follow-up and preoperation (P gt; 0.05) in patients whose diameter of the ascending aorta was more than 50 mm before operation. Conclusion Unsupported reduction ascending aortoplasty has good short- and mid-term results in treating aortic valve disease with mild to moderate dilatation (diameter range, 40-50 mm) of the ascending aorta. Inclusion criteria of the aortoplasty should be strict. Long-term results need further follow-up.
Abstract:The use of pulmonary autograft was first reported in 1967 by Ross for the treatment of aortic valve disease in adults. Since that time, Ross procedure has been applied to a variety of forms of aortic stenosis and left ventricular outflow tract obstruction and mitral valve disease, Ross procedure has undergone several modifications, such as the root replacement method, inclusion cylinder technique, annular reduction, Konno root enlargement procedures and replacement of the mitral valve with a pulmonary autograft （Ross-Kabbani procedure or Ross Ⅱ procedure）. Advantages of Ross procedure in women of childbearing age, children and young adults include freedom from anticoagulation, appropriate sizing, cellular viability with growth potential proportional to somatic growth, acceptable long-term durability, excellent hemodynamic performance and decreased susceptibility to endocarditis. Surgical technical aspects, indications, selection criteria for the Ross procedure and its modifications, their applicability in the surgical management of aortic stenosis, left ventricular outflow tract obstruction and mitral valve disease and clinical outcome of Ross procedure are reviewed in this article.
Objective To report the preliminary results of intraoperative saline-irrigated radiofrequency modified maze procedure for chronic atrial fibrillation (AF) in mitral valve diseases. Methods From May 2003 to April 2004 forty-one patients underwent intraoperative saline-irrigated modified maze procedure. The patients included 13 male and 28 female. Their age ranged from 27-65 years (46±10 years). The duration of AF varied from 5 months to 15 years (4.5±3.6 years).The left atrial diameter varied from 37-93 mm (54±11mm). There were mitral stenosis 20, mitral regurgitation 1 and mitral stenosis with regurgitation 20 cases. Cardiopulmonary bypass (CPB) was established as usual. Ablation lines were made with Cardioblate (Medtronic, 25-30 W, 180-240ml/h). Having finished right-sided maze procedure, the aorta was cross-clamped and cold crystalloid or blood cardioplegia were used for myocardial protection. Left atrial incision was performed through the interatrial groove. The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively. The ablation lines were also performed from the left encircling line to the posterior mitral valvular annulus and to the orifice of left atrial appendage respectively. A ablation line was used to connect left and right pulmonary veins circumferential line. Concomitant procedures were performed (there were double valve replacement 10 cases, mitral valve replacement 31 cases, tricuspid annuloplasty 6 cases, removing the left atrial thrombi 6 cases). Results CPB time varied from 71-160 min (105±24 min) and cross-clamping time varied from 32-106 min (62±20 min). The ablation time varied from 4-22 min (11±4 min). One patient died during hospitalization and the death was caused by acute mechanic valve obstruction. During follow-up at discharge and 3 months 35% patients (14/40) were free of AF and the others were not. But at 6 months 67% patients (10/15) were free of AF. Conclusion The intraoperative saline-irrigated radiofrequency modified maze procedure is comparatively simpler and its efficacy is satisfactory.
ObjectiveTo investigate the risk of cardiac valve regurgitation in patients with pituitary prolactinoma treated with bromocriptine for a long time. MethodsBetween January 2012 and February 2013, 26 pituitary prolactinoma patients treated with bromocriptine for at least 6 months were included in the observation group, and 101 healthy people were regarded as the control group. Transthoracic echocardiography were performed on these patients for cardiac regurgitation, and the echocardiographic data were compared between the two groups. ResultsTrace tricuspid regurgitation was presented in 38.46% of patients in the observation group, and 19.80% of the controls (P=0.046). Interventricular septum thickness was (8.62±0.31) mm in patients in the observation group, and it was (8.57±0.12) mm in the controls (P=0.042). ConclusionNo clinical significant cardiac valve regurgitation has been observed in pituitary prolactinoma patients treated by bromocriptin for a long time. Long-term echocardiographic follow-up of these patients is necessary.
Objective To investigate the effect of applying intraoperative epicardial echocardiography (IEE) on preoperative monitoring and evaluating the clinical result of cardiac surgery. Methods We retrospectively analyzed the clinical data of 248 patients treated in the Affiliated 105 Hospital of People’s Liberation Army and the First Affiliated Hospital of Anhui Medical University from June 2008 to May 2015. There were 108 males and 140 females. The age ranged from 7 months to 71 years. There were 113 patients diagnosed with the congenital heart disease (CHD) at the mean age of 11.89±14.74 years. There were 135 patients diagnosed with valvular heart disease at the mean age of 47.20±14.57 years. All patients underwent IEE during operation. Results In 113 patients with CHD, we found new deformities and corrected preoperative diagnosis before cardiopulmonary bypass (CPB) and we identified surgical complications after CPB by IEE. Other deformities and left atrial thrombus were found in 135 patients with valvular heart disease by IEE before CPB. After CPB, paravalvular leak and mitral regurgitation were found, therefore we took action immediately. Conclusions IEE can improve the preoperative diagnosis and reduce perioperative complications, which has value of application during cardiac surgery.
Objective To investigate the feasibility and effect of stentedpulmonary autograft replacement and find out the best way to treat mitral valve diseases. Methods From August 2006 to October 2007, 20 male sheep at the age of about 1 year old underwent mitral valves replacement operation in Anzhen Hospital. Weight of these sheep was 50.0±6.0 kg. They were randomly divided into two groups. Ten sheep in the experimental group underwent RossⅡsurgery in which we first sutured pulmonary valve onto a pulmonary valve stent, transferred the valve to the mitral valve annulus and then reestablished the outflow tract of the right ventricle. The other 10 sheep in the control group underwent bioprosthetic valve replacement routinely. Ultrasonic cardiogram (UCG) was employed 6 hour after operation to measure the effective orifice area (EOA) of the mitral valve, mitral peak velocity of early filling, the peak pressure gradient (PPG), the extent of regurgitation, left ventricular enddiastolic dimension (LVEDD) and ejection fraction (EF). Results One sheep in the experimental group died of low cardiac output syndrome; one in the control group died of unmanageable bleeding during operation, and the others all survived. Six hours after operation, UCG of the experimental group showed that the heart valves were well fixed, valve echo was clear, and there was no perivalvular leakage or mitral valve stricture or regurgitation, but moderate pulmonary valve regurgitation occurred in 1 case and mild in 2. There was no significant difference between the two groups in PPG (11.86±1.28 mm Hg vs. 10.98±0.98 mm Hg,t= 1.670,P=0.110) and the mitral peak velocity of early filling (1.72±0.09 m/s vs. 1.65±0.07 m/s, t=1.680,P=0.110). However, EOA of the experimental group was smaller than the control group (2.23±0.09 cm2 vs. 2.39±0.08 cm2, t= 4.240,P= 0.001). Conclusion The experimental result of sheep mitral valves replacement with stentedpulmonary autograft is satisfying. The new mitral valves work well and the surgery method is feasible.
ObjectiveTo explore the echocardiography characteristics of aortic valve disease (AVD) among different ethnic groups in Xinjiang.MethodsThe data of a large sample (n=130 358) of different ethnic groups in Xinjiang based on the results of echocardiography were analyzed between January 2011 and December 2016, and the echocardiography characteristics of AVD among the Han nationality and different ethnic minorities in Xinjiang were summarized.ResultsThe study recruited 130 358 patients, involving Han nationality (58.49%) and 33 ethnic minorities. The ethnic minorities included the Uygur (27.42%), Kazak (7.47%), Hui nationality (3.48%) and other minorities (3.13%). Apart from Uygur, Kazak and Hui nationality, no description was given due to the small sample sizes of other minorities (3.13%). In the total study population, the prevalence of aortic valve stenosis (AS) was 0.44%, and the prevalence of severe AS was 0.10%; the prevalence of aortic valve regurgitation (AR) was 0.37%, and the prevalence of severe AR was 0.02%; the prevalence of aortic valve calcification (AVC) was 6.51%, and the highest AVC prevalence existed in ≥75 years old age group (24.45%); the prevalence of bicuspid aortic valve (BAV) was 0.54%, and the highest BAV prevalence existed in 18-44 years old age group (0.86%). Among different ethnic groups, the Uygur had the highest prevalence in terms of AS (0.60%), AR (0.63%) and BAV (0.88%), while the Han had the lowest prevalence in terms of AS (0.37%) and AR (0.24%), but the highest AVC prevalence existed in the Han nationality (7.83%). The etiology of AVD showed that the degenerative valve changes was the main cause of AS with the largest proportion of 61.97%. While the aorta root diseases (35.97%) and BAV (22.87%) were the main etiology of AR.ConclusionsIn Xinjiang the overall prevalence of AVD is low. In the elderly population, the Uygur, Kazak and Hui nationality have the higher AS prevalence than the Han nationality does. Different ethnic groups have different AVD characteristics based on the echocardiography. In the Uygur group, AVD presents the younger age of onset; the prevalence of BAV is the highest in the Uygur population, while the lowest in the Hui nationality.