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Prosthetic Valve Endocarditis

Abstract: Prosthetic valve endocarditis(PVE) is a catastrophic complication of cardiac valve replacement, associated with high mortality rates. In the past nearly five decades, the microbiology, pathophysiology, clinical features, and therapeutic options in PVE have changed a lot, and there are new insight into the pathogenesis of PVE. The current comprehensive review will address various issues involved in the diagnosis and management of this complication.

右心房膨出瘤二例

肺部隐球菌病伴隐球菌性脑膜炎一例

动脉导管未闭封堵术后残余漏二例

风湿性心脏病人工瓣膜置换术后再发重度三尖瓣关闭不全的外科治疗

目的 评价风湿性心瓣膜病患者人工瓣膜置换术后三尖瓣重度关闭不全的外科处理效果. 方法 对11例风湿性人工瓣膜置换术后三尖瓣严重关闭不全患者行三尖瓣成形术和三尖瓣置换术;首次手术二尖瓣置换术5例,二尖瓣、主动脉瓣置换术6例,在首次手术中均曾行三尖瓣成形术,其中8例为Kay法,3例为De Vega法.再次手术在中低温体外循环下进行,对不需处理三尖瓣以外心内病变者,选择右侧前外侧切口,其余选择胸骨正中切口.行三尖瓣成形术6例;三尖瓣置换术5例,其中3例为机械瓣,2例为生物瓣,术后对有肾功能不全者行腹膜透析和床旁血液透析. 结果 术后肾功能不全6例,肝功能不全5例,肺功能不全3例,7例患者治愈出院;术后死亡4例. 结论 对人工瓣膜置换术后再发严重三尖瓣关闭不全者, 外科手术是一种合适的选择.

心内直视手术后气管切开及其处理方法

埃布斯坦综合征合并预激综合征的外科治疗

目的 为了提高手术疗效,总结埃布斯坦综合征(Ebstein syndrome)合并预激综合征的手术治疗经验. 方法 11例患者均有埃布斯坦综合征及严重三尖瓣关闭不全,合并A型预激综合征4例,B型 7例.术中电生理标测显示11例中有12条附加旁道,右心室游离壁6例,左心室游离壁3例,后间隔1例,后间隔和右心室游离壁双旁道1例.所有患者的房室附加旁道均在体外循环下被成功地手术切割;埃布斯坦综合征按Danielson方法行成形术9例,三尖瓣置换术2例. 结果 全组11例无手术后早、晚期死亡;术后随访4个月～6年,平均随访3.4±1.3年,无预激综合征复发,2例有轻度三尖瓣关闭不全.心功能Ⅰ级9例,Ⅱ级2例. 结论 手术治疗埃布斯坦综合征合并预激综合征,可同时纠正埃布斯坦综合征伴三尖瓣关闭不全和预激综合征,治疗效果良好.

先天性主动脉瓣二叶化畸形的外科治疗

目的 探讨先天性主动脉瓣二叶化畸形的诊断、适宜手术时机、围术期处理以及手术疗效. 方法 60例患者被施行心瓣膜置换术,行主动脉瓣机械瓣置换术56例,行自体心包瓣置换术4例;同时行主动脉窦瘤破裂修补术2例,胸主动脉瘤修补术2例,动脉导管未闭缝扎术3例,室间隔缺损修补术5例,冠状动脉旁路移植术3例.其中伴感染性心内膜炎25例. 结果 术后早期死亡5例,死亡率为8.3%.随访49例,平均随访时间5.4年,5年生存率为84.3%. 结论 先天性主动脉瓣二叶化畸形以男性居多,左、右二叶型较前、后型常见,可致主动脉瓣关闭不全和/或狭窄,以关闭不全多见(75%).出现充血性心力衰竭、心绞痛、晕厥、感染性心内膜炎时应尽早行手术治疗,症状不明显的患者应定期复查超声心动图,主动脉瓣置换术是常用的手术方法.

The analysis of mitral valve replacement on the old

Objective To study effects of mitral valve replacement(MVR) on the old with mitral valve diseases(MVD). Methods The documents of 265 cases undergoing MVR were reviewed, who aged 60 years old or over between June 1991 and June 2003. Demographices, clinical preoperative conditions, indications to surgery, early postoperative course and long-term outcome were collected via hospital documents and outpatient follow-up. Many risk factors were analysed. Results Follow-up rate amounted to 93.7%(236/252). The mortality was 4.9% (13/265) within 30 days. Heart failure and renal failure were the main cause of death. Compared with younger patients(lt;60 years old), long-term survival rate was lower in the old, 5-year 87.52% vs 96.84%, 10-year 81.23% vs 94.87%. There were 15 late deaths(0.17% case/M), most of whom died of heart failure, cancers and lung infections. Risk factors for MVR in the old included New York Heart Association class Ⅳ, diabetes, and lung incompetence. Conclusions The patients with MVD over 60 years old tended to present high postoperatively mortality and morbidity.

胸主动脉夹层的再次手术治疗

目的分析胸主动脉夹层术后复发的原因,总结其外科治疗经验。方法回顾分析4例主动脉夹层术后复发患者行手术治疗的临床资料,其中行Bentall手术2例,胸主动脉置换术2例。结果全组无手术死亡,术后并发呼吸及肾功能不全1例,声音嘶哑1例。结论胸主动脉夹层术后再发与原发病、血压控制不良、第1次手术适应证的选择有关,急性DeBakeyI、II型患者应行急诊手术治疗。