改良上下腔静脉阻断法在微创心脏手术中的应用

目的 总结改良上下腔静脉阻断法在胸腔镜辅助右胸小切口微创心脏手术中应用的可行性.方法 2011年7月至2013年11月,应用胸腔镜辅助右胸小切口微创心脏手术技术,结合使用“哈巴狗”钳及肠钳阻断上下腔静脉完成微创心脏手术24例,其中房间隔缺损修补术6例,室间隔缺损修补术5例,右房黏液瘤摘除术1例,二尖瓣置换术同期三尖瓣成型术12例.结果 全组手术顺利,术中上下腔静脉阻断充分,无漏血,无上下腔静脉损伤,无围术期死亡,所有患者均顺利出院.结论 改良上下腔静脉阻断法在胸腔镜辅助右胸小切口微创心脏手术中应用,安全、简单容易、阻断效果满意.     

3D胸腔镜在再次二尖瓣/三尖瓣手术中的应用

目的 分析3D胸腔镜在再次心脏手术中的应用情况,总结手术技巧与经验。方法 2015年4月至2018年5月,郑州市第七人民医院胸腔镜下再次二尖瓣/三尖瓣手术29例,为腔镜组;回顾2010年1月至2015年1月郑州市第七人民医院常规再次心脏手术患者资料,适合胸腔镜下手术但行常规手术51例,为常规组。结果 ①两组手术时间（198.42±46.51 VS 316.51±126.81,t=8.92,P<0.01）、体外循环时间（125.86±62.92 VS 193.13±84.47,t=5.93,P<0.01）、呼吸机辅助呼吸时间（15.25±6.12 VS 30.46±11.93,t=10.07,P<0.01）、重症监护时间（31.61±21.25 VS 51.43±35.21,t=3.48,P<0.01）,3D腔镜组明显短于常规组;引流量（354±112.69 VS 692.28±371.57,t=19.34,P<0.001）和红细胞使用率（4 VS 23,t=8.10,P<0.05）和血小板使用率（1 VS 24,t=16.37,P<0.001）,3D腔镜组显著少于常规组;围术期疼痛评分,3D腔镜组显著低于常规组（3.05±0.69 VS 6.28±1.57,t=7.16,P<0.001）;围术期死亡率和并发症发生率无显著区别。②3D胸腔镜再次二尖瓣/三尖瓣手术,1年后生活质量和心脏功能较常规手术无显著区别。结论 再次心脏手术中,3D胸腔镜是具有微创、安全、可行的特点,值得开展胸腔镜心脏手术单位临床推广。     

临时阻断技术在脑动脉瘤手术中的应用

在动脉瘤手术中，为了降低术中动脉瘤破裂的发生率及避免产生严重的并发症，常应用临时阻断技术。文章对应用临时阻断技术的相关因素进行综述。     

微创镶嵌手术在复杂先天性心脏病治疗中的应用进展

复杂先天性心脏病发病率较高,治疗过程较为复杂。复杂先天性心脏病主要分为青紫型和体循环灌注不足型。对复杂先天性心脏病,传统外科手术和微创介入手术的应用均受到限制。镶嵌手术是将介入技术与外科手术有机结合的复合技术,能做到取长补短,为患者提供最佳的治疗方案。     

再次心脏手术行三尖瓣瓣膜置换患者的术后重症监护要点

目的 探讨再次心脏手术行三尖瓣瓣膜置换术的患者术后重症监护的要点.方法 对49例再次心脏手术行三尖瓣瓣膜置换术患者的临床资料进行回顾性分析,着重分析其术后重症监护措施.结果 49例患者中治愈出院38例,死亡11例.结论 加强此类患者的术后重症监护措施可以降低术后并发症的发生率和死亡率,促进疾病康复.     

左心瓣膜术后单纯性三尖瓣关闭不全的微创治疗方案及围术期结果

目的 分析全胸腔镜手术治疗左心瓣膜术后单纯性重度三尖瓣关闭不全的围术期结果,探讨全胸腔镜手术在再次三尖瓣手术中的优势及临床效果。方法 回顾性收集2018年1月至2023年12月在解放军总医院第一医学中心心脏大血管外科接受全胸腔镜三尖瓣手术治疗的左心瓣膜术后单纯性重度三尖瓣关闭不全患者的临床资料。共计134例患者符合标准纳入研究,总结其围术期临床资料以及治疗经验。其中72例(53.7%)患者行三尖瓣成形术(三尖瓣成形组),62例(46.3%)患者行三尖瓣置换术(三尖瓣置换组),比较两组相关指标。结果 134例患者体外循环中位时间为92 min,平均手术时间为(183.8±56.1)min。2例(1.5%)患者体外循环撤机后出现右心功能不全,后予以体外膜肺氧合支持,于术后1周内顺利撤机。术中输注血制品54例(40.3%)。术后患者呼吸机辅助通气中位时间为13.0 h。重症监护室(ICU)停留中位时间为2.0 d,引流管拔除中位时间为2.0 d,术后胸腔引流量中位数为475.0 mL。16例患者出现术后早期并发症,包括室颤2例,胸腔积液4例,住院再手术2例,起搏器植入8例。无术后早期死亡。三...     

腔内微创手术治疗输尿管结石合并输尿管远端狭窄的安全性及有效性分析

［摘要］　目的　分析输尿管结石合并输尿管远端狭窄采用腔内微创手术治疗的安全性及有效性。方法　回顾性分析2014-01～2019-11该院泌尿外科收治的50例输尿管结石合并输尿管远端狭窄患者的临床资料,术前完善相关检查明确诊断为输尿管结石,采用输尿管硬镜手术,术中发现输尿管远端狭窄输尿管镜无法进镜,采用COOK输尿管扩张器行输尿管狭窄扩张成功后顺利完成手术;狭窄严重扩张失败者留置双J管二期行输尿管硬镜或软镜手术治疗,术后3个月行B超、静脉肾盂造影等检查评估结石清除情况及输尿管通畅情况。结果　50例患者中有36例（72.0%）采用COOK输尿管扩张器扩张输尿管狭窄后一期行输尿管硬镜碎石治疗成功;其余14例采用COOK输尿管扩张器扩张输尿管狭窄失败,输尿管镜无法进镜,放置双J管,根据输尿管狭窄程度,2周到2个月后二期行腔内微创手术治疗,其中7例行输尿管镜气压弹道碎石治疗成功,5例通过输尿管软镜钬激光碎石治疗成功,2例二期行输尿管镜检查发现结石已自行排出。结论　输尿管结石合并输尿管远端狭窄可采用COOK输尿管扩张器扩张后一期输尿管镜碎石,如因输尿管狭窄严重、扩张输尿管后输尿管镜仍进镜困难,放置双J管二期腔内微创碎石,这是一种安全有效的微创治疗方法。     

Minimally invasive tricuspid valve surgery

Tricuspid valve disease carries a very unfavorable prognosis when medically treated. Despite that, surgical intervention is still underperformed for tricuspid valve disease due to the reported high morbidity and mortality from a sternotomy approach. This had led to a shift towards maximizing medical therapy for right ventricular failure and, as a result, a more significant delay in surgical referrals with surgical risks when patients are finally referred. Tricuspid valve patients usually have other co-morbidities resulting from their systemic venous congestion and low flow cardiac output. Minimally invasive tricuspid valve surgery provides less tissue injury and, as a result, less trauma during surgery. This provides a hope for both patients and treating doctors to be more open for providing this procedure with less complications. Isolated minimally invasive tricuspid valve surgery is still not performed as widely as expected. This can be partly due to the adverse outcomes historically labelled to tricuspid valve surgery or by the long journey of learning the surgical team would need to commit to with a minimal access approach. In this article we will review the perioperative pathway, and outcomes of isolated minimally invasive tricuspid valve surgery in the available English literature.     

Outcome and determinants of prognosis in patients undergoing isolated tricuspid valve surgery: Retrospective single center analysis

Aims

Although tricuspid valve (TV) surgery has become more popular, isolated TV surgery is infrequently performed. The aims of this study were (1) to evaluate the postoperative and long-term mortality of patients undergoing isolated TV surgery, (2) to compare the outcomes of patients undergoing their first TV surgery or TV reoperation, and (3) to assess the additive value of echocardiographic and invasive hemodynamic evaluations for predicting postoperative outcome.

Methods

We followed a contemporary cohort of patients undergoing isolated TV surgery from January 1, 1995, through December 31, 2011. Preoperative demographic, echocardiographic, hemodynamic, and operative data were included. Outcome was all-cause mortality.

Results

Ninety-two patients (38% male; mean age: 56 ± 14 years) were included. Kaplan-Meier survival analyses showed that 30-day, 3-month, 5-year, and 10-year mortality were 7.9%, 15.2%, 25.7%, and 53.7%, respectively. No difference in outcome was found between patients undergoing first TV surgery (n = 61) and TV reoperation (n = 31) (p = 0.669). Univariable Cox analysis identified age (p < 0.0001), extracardiac vascular disease (p = 0.001), glomerular filtration rate (p = 0.022), NYHA classification (p = 0.010), and mean pulmonary artery pressure (p = 0.005) as predictors of mortality. Multivariable analysis identified significant associations with outcome, only for age (p = 0.010) and NYHA functional class (p = 0.044). In younger patients (< 59 years), mean pulmonary artery pressure was associated with the worse outcome (p = 0.024).

Conclusions

Isolated TV surgery is still associated with important postoperative and long-term mortality, both for first TV surgery and TV reoperation. Pre-operative NYHA functional class and, in younger patients, pulmonary hypertension appear to determine prognosis.     

Imaging and monitoring in minimally invasive valve surgery using an intra-aortic occlusion device: a single center experience

BackgroundMinimally invasive approach through a right mini-thoracotomy is a world-wide used procedure for mitral valve surgery. We performed a retrospective analysis based on our center experience in order to propose an effective, safe and reproducible method using an intra-aortic occlusion device.MethodsThis is a retrospective analysis on 48 consecutive patients undergoing mitral valve surgery through a right anterolateral mini-thoracotomy in our center. An intra-aortic occlusion device was used for aortic clamping and cardioplegia delivery. Simultaneous multi-plane three-dimensional echocardiography imaging was acquired to detect the venous cannulas position, the intra-aortic device location in the ascending aorta, the balloon inflation, the complete occlusion of the aorta, the cardioplegia delivery, the origin and the blood flow in the right coronary artery. Aortic root pressure was measured by the tip of the intra-aortic occlusion device. A bilateral upper extremity invasive arterial pressure monitoring was detected. Neuromonitoring was performed through bilateral cerebral oximetry.ResultsThe analysis has shown no aortic dissection, neurological damage type 1 and myocardial ischemia in the study population. In 3 cases a distal displacement of the intra-aortic occlusion device was promptly detected by the combined use of echocardiographic imaging and by a drop of the right cerebral oximetry saturation and of the right radial artery pressure.ConclusionsThe combined use of transesophageal simultaneous multi-plane three- dimensional echocardiography imaging, bilateral upper extremity invasive arterial pressure monitoring, aortic root pressure and cerebral oximetry is an effective, safe and reproducible method in patients undergoing minimally invasive valve surgery using an intra-aortic occlusion device.     

三尖瓣置换术后近期疗效

目的 总结重度三尖瓣病变行三尖瓣置换的临床经验。方法 回顾分析泰达国际心血管病医院2005年6月至2015年7月39例三尖瓣置换临床资料。结果 行生物瓣置换24例,双叶机械瓣15例,围术期出现多脏器功能衰竭7例,应用ECMO支持2例,CRRT2例,死亡3例,三度房室传导阻滞2例; 36例顺利出院,术后随访2个月-3年,失访6例,全因死亡4例,心因性死亡2例,瓣膜血栓1例,其余恢复良好。结论 对三尖瓣严重病变患者三尖瓣置换术是可行的,早期死亡率可以接受,积极有效的围手术期处理,可以获得满意的临床疗效。     

Isolated calcification of tricuspid valve with severe low pressure tricuspid regurgitation in an infant

A three-month-old asymptomatic male infant was evaluated for a systolic murmur. Echocardiography revealed calcification of tricuspid leaflets with severe low pressure tricuspid regurgitation. Pulmonary artery flow was normal. There was no other congenital anomaly.     

左心瓣膜术后心房颤动与三尖瓣反流的关系

目的:研究左心瓣膜术后三尖瓣反流与术后心房颤动(房颤)的关系。方法:随访2002年3月至2008年11月接受主动脉瓣置换术或二尖瓣置换术,且未行三尖瓣成形术或三尖瓣置换术的患者374例,其中男性151例,女性223例,年龄23～79岁,平均(52±11)岁。所有患者均经过术前和术后彩色多普勒超声心动检查及心电图检查。单因素分析组间使用χ2检验。危险因素采用Logistic回归模型分析。结果:左心瓣膜术后房颤是术后发生三尖瓣反流的独立危险因素。Logistic多因素分析结果为:术后房颤、女性及术后左心房扩大,是术后三尖瓣反流的独立危险因素;术时年龄、术后左心室大小、术后右心室大小及术后射血分数这4项不是三尖瓣反流的危险因素。结论:左心瓣膜术后房颤是术后发生三尖瓣反流的独立危险因素。对于术后房颤应该引起重视,积极治疗。     

Three-dimensional echocardiography of a tricuspid valve papillary fibroelastoma

Papillary fibroelastomas (PFE) on tricuspid valve (TV) are rare, accounting for fewer than 11% of all PFE. Most often they are asymptomatic, and detect on mitral valve. We report a case of a typical chest pain found to be due to papillary fibroelastoma of the tricuspid valve.