Abstract:Since 1978 the definition of prosthesis-patient mismatch（PPM） was first introduced by Rahimtoola, it has attracted the attention of foreign researchers. The PPM phenomenon is concerned to be an important factor which will affect patients＇ survival rate and quality of life. Till now, a lot of effort should still be put on this problem. But unfortunately, this problem is still being neglected in our country. This paper is a review of PPM from it＇s many aspects, such as definition, current research status, prevention, and it＇s research prospect. We hope this paper will intensify the clinicians＇ knowledge on PPM.
Technical advances both in cardiac surgery and relating to anesthesia,cardiopulmonary bypass and myocardial protection have significantly improved the prognosis for patients combined with coronary heart disease and heart valve disease. In addition to technology, variable factors that affect operative survival following combined operation include the severity of valvular disease, the number of coronary vessels affected, impairment of left ventricular function and both age and gender differences. In this article, we review the outcome of surgical intervention for heart valve disease combined with coronary heart disease and discuss future prospects in this field.
Objective To investigate the perioperative changes of serum brain natriuretic peptide (BNP) concentrations in patients undergoing cardiac valve replacement. Methods There were 20 patients admitted to the study, the serum BNP concentrations were measured before cardiac surgery, 24 hours, 7days, 14 days, and 30 days after operation. The preoperative NYHA cardiac function and the left ventricular ejection fraction(LVEF) were measured by echocardiogram. Results The preoperative BNP level was the baseline, it elevated markedly and acutely to a peak value 24 hours after operation ( P =0.003), then the BNP decreased 7 days later, but was still higher than the concentration before operation ( P =0.015), 14 days later it reached to the concentration before operation, 30 days later it was mild lower than preoperative BNP level, but there was no significant difference. There was a positive correlation between NYHA and BNP ( r =0.69, P lt;0.05), but no correlation between LVEF and BNP( r =0.29, P gt;0 05). Conclusion The preoperative serum BNP concentration can reflect the preoperative cardiac function in patients undergoing cardiac valve replacement, the high BNP level indicates the poor cardiac function. The BNP sharply elevated in the early time after operation, then gradually decreased in the late phase postoperation.
Objective To modify the method for aortic end strengthening in acute type A aortic dissection operation, and investigate its clinical efficacy. Methods We modified the method for aortic end strengthening in acute aortic dissection operation based on ‘Sandwich method’ in the department of thoracic and cardiovascular surgery of West China Hospital. From January 2006 to December 2008, twentyeight patients with acute type A aortic dissection underwent modified aortic end strengthening operation. We made adventitia turn over and enfold to strengthen the aortic end in 10 cases, and placed stripshaped felt or pericardium belts between dissection (between adventitia and intima)and inner intima and strengthened the aortic end by suture in 18 cases. The hemorrhage of anastomotic stoma and the postoperative early prognosis were observed. Results No bleeding complication was found in all the cases. Two cases died, one died of severe low cardiac output syndrome and another died of multiple organ failure. No nervous system complication was found except that 2 cases had delayed revival. No sternum and surgical incision related complication was found. The rest 26 cases were cured and discharged. Conclusion The modified method for aortic end strengthening can not only strengthen the aortic end but also make people be able to find the petechia of anastomotic stoma clearly, then stitch hemostasia could be done effectively. The method is easy to implement and effective, it should be extend in clinic.