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Objective To compare the safety and efficacy between transcatheter intervention and surgical closure of para-valvular leakage(PVL)after valve replacement.Methods From May 2010 to May 2014,17 patients of paravalvular leakage af-ter valve replacement underwent interventional therapy and 11 patients underwent surgical closure.The perioperative charac-ters, mortality rate, complications and prognosis were compared between the patients underwent surgical procedure and tran-scatheter intervention.The average follow-up time was 13 months(1-36 months).Results The success rate of transcatheter intervention was 100%, while there were 2 in-hospital deaths in the surgical group(18%).Compared with surgical group, transcatheter intervention group has the benefit of shorter operation time[(84 ±36)min vs.(358 ±88)min](P<0.01),shor-ter hospitalization time[(11.9 ±12.1)d vs.(38.1 ±42.2)d](P<0.05), less transfusion[(1 029 ±455)ml vs.(1 438 ± 908)ml](P<0.05).There was no mechanical ventilation and ICU stay in the transcatheter intervention group.After tran-scatheter intervention, there was 7 residual shunt(47%)with an average shunt volume of(1.6 ±1.7)ml,which is remarkably reduced compared with pre-operation.In the surgical group, there was 1 case of residual shunt(9%).During the follow-up, there was no deaths in both groups, with improved heart function and no serious complications.Conclusion In the treatment of paravalvular leakage after valve replacement,transcatheter interventiontechnique has the advantages of simpler and safe ap-proach, less trauma, shorter time of hospitalization,faster post-operative recovery and lower treatment cost.This method is one of the new technology in the field of minimally invasive cardiac surgery in recent years.By improving operation skills,choosing individualized occluders and treatment of early hemolytic complications, the success rate and long-term effect of interventional therapy can get further improved.
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Objective To observe surgical outcome of reoperation for paravalvular leakage and medium- and long-term survival. Methods The clinical data of 28 patients receiving reoperation for paravalvular leak (PVL) in General Hospital of PLA between October 1998 and October 2015. The patients included 22 males and 6 females, with a mean age of 55.3 years (ranging from 15-67 years). PVL was reported in 18 cases after mitral valve replacement, in 4 after aortic valve replacement, in 4 after multiple valve replacement (mitral PVL), in 1 case after multiple valve replacement (multiple PVL) and in 1 after radical surgery for trilogy of Fallot with tricuspid valve replacement (tricuspid PVL). There were 2 cases diagnosed as infective endocarditis contributing to PVL. The grades of heart function were NYHA II in 11 patients, NYHA III in 10, NYHA IV in 7. Results Two patients died in hospital because of septic shock and MODS respectively. One patient developed hypoxic-ischemic encephalopathy after operation. There were 2 patients undergoing second thoracotomy on account of drainage post-operatively. One patient suffered recurrence of PVL. Twenty-two out of 26 patients were followed-up for 12 to 219 months (average 76.21 months) and 4 were lost to follow-up. One patient died of severe pancreatitis 31 months after hospital discharge and 1 had recurrence of PVL with heart function NYHA III. Twenty-four survivals are in NYHA class II. Conclusion Aggressive operation is effective treatment for moderate-severe PVL diagnosed by cardiac ultrasonography.
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<b>Objective</b> : The aim of this study is to describe a series of patients undergoing reoperation due to hemolytic anemia after mitral valve surgery and assess the mechanisms and surgical outcomes. <b>Methods</b> : Between 2009 and 2014, we performed redo mitral valve surgery in 11 patients who had refractory hemolytic anemia after mitral valve surgery at Kyoto University Hospital. The mean age of the patients was 72.2±6.8 years old, and there were 5 men. <b>Results</b> : Preoperative echocardiography demonstrated that only 3 patients had ≥ grade 3 mitral regurgitation (MR), the rest of the patients had only mild to moderate MR. The mechanisms of severe hemolysis included paravalvular leakage (PVL) after mitral valve replacement (MVR) in 8 patients, structural valve deterioration (SVD) after MVR using a bioprosthesis in one, and residual/recurrent mitral regurgitation after mitral valve plasty (MVP) in two. All the patients except one (re-MVP) underwent MVR. The mean interval between previous operation and current operation was 14.1±9.4 years in post-MVR cases, and 2.0±1.9 years in post-MVP cases. There were three late deaths, one of which was due to cardiac death (exacerbation of heart failure due to pneumonia). There was one patient who required re-MVR for recurrent hemolysis due to PVL after MVR. <b>Conclusion</b> : Although hemolytic anemia after mitral valve surgery is rare, it often requires reoperation regardless of the degree of MR at late follow-up period. Thus, patients after mitral valve surgery should be carefully followed-up.
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<b>Objective</b> : The aim of the present study is to show the continuous suture technique in which the aortic valve replacement can be safely performed to insert prosthetic valves of an appropriate size in patients with aortic stenosis associated with a small annulus. <b>Patients and Methods</b> : Thirteen patients with severe aortic valve stenosis (aortic valve area <1.0 cm<sup>2</sup>) underwent aortic valve replacement with the continuous suture technique using three 2/0 non-absorbable monofilament polypropylene sutures. Transthoracic echocardiogram was performed before and after surgery in all patients to determine how large a prosthetic valve could be used compared to the preoperative annular size. <b>Results</b> : The mean size of the prosthetic valve implanted was 23.3 mm, while the preoperative mean value of aortic annulus was 21.7 mm. The 19 mm size prosthetic valves were never used even when the preoperative aortic annular diameter was less than 19 mm (in 2 patients). The duration of procedure time was adequate and the post-operative echocardiography showed excellent results with good prosthetic valve function and no adverse events. <b>Conclusions</b> : Using our continuous suture technique, prosthetic valves of an appropriate size can be safely and effectively inserted at an aortic position in patients with severe aortic stenosis.
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Sutureless aortic valve replacement was performed in a 72-year-old female patient with severe aortic stenosis who had undergone coronary revascularization and pacemaker implantation. After valve excision, decalcification was deliberately incompletely performed at the commissure of the left- and non-coronary cusp to obtain a regular and circular annular margin. After implantation of the stented valve, no paravalvular leakage was noted on water irrigation testing. Upon weaning from cardiopulmonary bypass, a moderate degree of paravalvular leakage was observed by transesophageal echocardiography at the junction of the left- and non-coronary cusp. Instead of removing the valve and performing more complete decalcification to implant a larger valve, secondary balloon dilatation and warm sterile water irrigation were performed to allow further expansion and fixing of the metal alloy stent around the aortic wall to minimize the duration of aortic cross-clamp. No paravalvular leakage was observed thereafter and the patient was discharged without any complications.
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Aged , Female , Humans , Alloys , Aortic Valve Stenosis , Aortic Valve , Cardiopulmonary Bypass , Dilatation , Echocardiography, Transesophageal , Stents , Water , WeaningABSTRACT
Objective To assess the application values of real-time three-dimensional transesophageal ultrasound (RT3D-TEE) technology in the diagnosis and treatment of artificial mitral paravalvular leak (PVL). Methods Fifty-one cases of artificial mitral PVL patients were received two-dimensional transesophageal ultrasound (2D-TEE) and RT3D-TEE examination before and after surgery. Accuracy analysis was performed between the two kinds of test. Results The diagnostic accuracy of RT3D-TEE technique in patients with PVL drain port positionwas significantly higher than that of 2D-TEE technology , and the data of PVL drain port size by RT3D-TEE technique is significantly larger than that of 2D-TEE technique (P < 0.05, respectively). Conclusion The PVL laboratory diagnosis based on RT3D-TEE is accurate and reliable , and RT3D-TEE can assist doctors to diagnose before operation , and can provide real-time ultrasound information from intraoperative monitoring , and monitor the postoperative efficacy of patients .
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Objective: To evaluate the surgical efficacy of valve replacement for severe paravalvular leakage (PVL) by echocardiogram. Methods: From June 2000 to December 2007, 26 patients with severe PVL were admittted to our hospital. The patients included 19 males and 7 females, with a mean age of 48 years (ranging 33 to 68 years). Severe PVL was reported in 11 cases after aortic valve replacement and 15 mitral valve replacement. The grades of cardiac function was in NYHA III (16 cases) and IV (10 cases). Preoperation echocardiogram combined with intraoperation findings was the main diagnosis approach. Nineteen patients (73.1%) underwent a second valve replacement (RO group) and 7 (26.9%) were managed conservatively (MC group). Results: One patient died of MODS early after operation in the RO group. During 2 months to 8 years follow-up (mean 2.7 years), one patient had recurrence of paravalvular leakage 2 months later and died of heart failure 5 months later after refusing a second operation. In MC group, one patient died of multiple organ failure in hospital; the rest died within 6 months after operation. Conclusion: Surgical treatment for patients with echocardiogram-diagnosed severe PVL should be performed as early as possible. The mortality and morbidity of conservative therapy are extremely high. Re-operation can greatly improve the long-term survival of the patient and the heart function.
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BACKGROUND: Better imaging resolution and less flow masking with TEE than with TTE makes it easier to evaluate the prosthetic valve dysfunction. However, direct comparison between two methods to evaluate prosthetic valve dysfunction remains elucidated. METHODS: Both TTE and TEE were performed in 19 patients with suspected prosthetic valve dysfunction who were admitted to Seoul National University Hospital for evaluating porsthetic valve dysfunction from July, 1992 to May, 1993 and those findings were compared with those of cardiac catheterization and angiography, and surgery 19 cases were included in this study. RESULTS: 11 patients with congestive heart failure underwent TTE, TEE and angiography and each finding was compared to one another. We could see that there is good correlation between transesophageal echocardiographic and angiographic grading in the severity of regurgitation but poor correlation between transthoracic echocardiographic and angiographic finding in that of regurgitation. We also could differentiate between central and eccentric leakage with TEE and in 2 cases TEE enabled us to detect a vegetation on prosthetic valve not detected with TTE and in 1 case the cause of cardiac hemolysis could be known with TEE : eccentric leakage in prosthetic mitral valve. Left atrial thrombi were detected with TEE in two patients with recent cerebral infaction history. CONCLUSION: We conclude that TEE is a good method that enables us to diagnosize the prosthetic valve dysfunction and detect the structural abnormalities surrounding prosthetic valve such as paravalvular leakage, vegetation, cardiac hemolysis and Left atrial thrombi not detected easily by TTE.