A Case of Redo-Mitral Valve Replacement for a Björk-Shiley Delrin Valve Implanted 47 Years Previously / 日本心臓血管外科学会雑誌

We report a case of redo mitral valve replacement (MVR) for a Björk-Shiley Delrin valve implanted 47 years previously. A 71-year-old man initially underwent MVR for mitral regurgitation at our hospital at the age of 16 years. Following the operation, follow-up examinations were performed at the outpatient clinic and annual transthoracic echocardiogram findings showed only mild mitral regurgitation, with no adverse events noted. However, a transthoracic echocardiogram examination performed 45 years after the operation revealed mild to moderate mitral regurgitation, while dyspnea with exertion was also noted at that time. As part of a more detailed examination, transesophageal echocardiogram results showed moderate transvalvular leakage. Redo MVR was subsequently performed under the diagnosis of prosthetic valve dysfunction. Analysis of the explanted prosthetic valve revealed wear of the Delrin disk, and widening of the gap between the disk and strut, which were presumed to be the cause of transvalvular leakage. A half century has passed since introduction of the Björk-Shiley valve and the present is a rare case of valve malfunction. Presented here are related details, along with a review of existing literature and results of Björk-Shiley valve use at our hospital.

Treatment of moderate functional mitral regurgitation during aortic valve replacement in patients with aortic valve disease: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the impact of different surgical strategies for moderate functional mitral regurgitation (FMR) at the time of aortic valve replacement (AVR) on patients' prognosis. Methods    A total of 118 AVR patients, including 84 males and 34 females, aged 58.1±12.4 years, who were complicated with moderate FMR were retrospectively recruited. Patients were divided into three groups according to the treatment strategy of mitral valve: a group A (no intervention, n=11), a group B (mitral valve repair, n=51) and a group C (mitral valve replacement, n=56). The primary endpoint was the early and mid-term survival of the patients, and the secondary endpoint was the improvement of FMR. Results    The median follow-up time was 29.5 months. Five patients died perioperatively, all of whom were from the group C. Early postoperative FMR improvement rates in the group A and group B were 90.9% and 94.1% (P=0.694). The mid-term mortality in the three groups were 0.0%, 5.9% and 3.9%, respectively (P=0.264), while the incidences of major cardiovascular and cerebrovascular events were 0.0%, 9.8% and 17.7%, respectively (P=0.230). Improvements of FMR in the group A and group B were 100.0% and 94.3% at the mid-term follow-up (P>0.05). Conclusion    For patients receiving AVR with moderate FMR, conservative treatment or concurrent repair of mitral valve may be more reasonable, while mitral valve replacement may increase the incidence of early and mid-term adverse events.

Re-repair Mitral Valve Replacement for Paravalvular Leaks Unsuitable for Catheter Treatment / 日本心臓血管外科学会雑誌

We report a case of re-repair mitral valve replacement (MVR) for paravalvular leaks that were unsuitable for catheter treatment. Three years ago, a 67-year-old woman, who had undergone MVR for rheumatic mitral valve replacement at the age of 33 years and undergone re-MVR at the age of 47 years, was admitted with hemolytic anemia. We performed paravalvular leak (PVL) repair directly with 5-0 polypropylene sutures because of calcifications in the annulus. Three years after the operation, she presented with dyspnea on exertion, and transthoracic echocardiography revealed several paravalvular leaks. We consulted with cardiologists in our and other institutions, and these leaks were determined to be unsuitable for catheter treatment. We removed the artificial valve, and found the calcifications and residual cuffs from the first or second artificial valves. These residual cuffs were removed with Cusa® and Harmonic Synergy®. We performed re-repair MVR without reconstruction of the annulus. She was discharged on postoperative day 39 with no complications and did not experience any recurrence of PVL for 2 years. Residual cuffs from the artificial valve may cause PVLs, and Cusa® and Harmonic Synergy® are useful for removing residual cuffs and calcifications.

Valve in Valve transcatheter mitral valve replacement by a transvenous, transseptal access: A case report / 中国胸心血管外科临床杂志

@#Reoperation due to degenerated bioprostheses is an important factor of high-risk thoracic surgeries. In 2020 ACC/AHA guideline, Valve in Valve (ViV) was recommended for high-risk patient instead of surgical mitral valve replacement. This report described a 77-year-old male patient with a failed mitral bioprosthetic valve, evaluated at high risk of surgery, received a transvenous, transseptal transcatheter mitral valve replacement (TMVR). Tracheal intubation was removed at CCU 3 h after surgery without discomfort such as polypnea. The patient was transferred out of the CCU and discharged on the 3rd day. Compared with transapical access, transvenous transseptal access was less invasive, with shorter duration in CCU and hospitalization.

Implante Percutâneo Transeptal de Bioprótese em Disfunção de Prótese Valvar Cirúrgica Mitral - Experiência Multicêntrica Brasileira / Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience

Resumo Fundamento A intervenção percutânea em pacientes com disfunção de prótese biológica mitral apresenta-se como uma alternativa ao tratamento cirúrgico convencional. Objetivo Relatar a primeira experiência brasileira de implante transcateter de bioprótese valve-in-valve mitral via transeptal (TMVIV-via transeptal). Métodos Foram incluídos pacientes portadores de disfunção de bioprótese cirúrgica submetidos ao TMVIV-transeptal em 12 hospitais brasileiros. Foram considerados estatisticamente significativos valores de p<0,05. Resultados Entre junho/2016 e fevereiro/2019, 17 pacientes foram submetidos ao TMVIV-via transeptal. A mediana de idade foi 77 anos (IIQ,70-82), a mediana do escore STS-PROM foi 8,7% (IIQ,7,2-17,8). Todos os pacientes tinham sintomas limitantes de insuficiência cardíaca (CF≥III), tendo 5 (29,4%) sido submetidos a mais de uma toracotomia prévia. Obteve-se sucesso do TMVIV-via transeptal em todos os pacientes. A avaliação ecocardiográfica demonstrou redução significativa do gradiente médio (pré-intervenção, 12±3,8 mmHg; pós-intervenção, 5,3±2,6 mmHg; p<0,001), assim como aumento da área valvar mitral (pré-intervenção, 1,06±0,59 cm2; pós-intervenção, 2,18±0,36 cm2; p<0,001) sustentados em 30 dias. Houve redução significativa e imediata da pressão sistólica de artéria pulmonar, com redução adicional em 30 dias (pré-intervenção, 68,9±16,4 mmHg; pós-intervenção, 57,7±16,5 mmHg; 30 dias, 50,9±18,7 mmHg; p<0,001). Durante o seguimento, com mediana de 162 dias (IIQ, 102-411), observou-se marcada melhora clínica (CF≤II) em 87,5%. Um paciente (5,9%) apresentou obstrução de via de saída de ventrículo esquerdo (VSVE), evoluindo para óbito logo após o procedimento, e outro morreu aos 161 dias de seguimento.Conclusão: A primeira experiência brasileira de TMVIV-transeptal demonstra a segurança e a efetividade dessa nova técnica. A obstrução da VSVE é uma complicação potencialmente fatal, reforçando a importância da seleção dos pacientes e do planejamento do procedimento. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment. Objectives To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV). Methods Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05. Results From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm2; post-intervention, 2.18±0.36 cm2; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up. Conclusion The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients' selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Estenosis mitral con calcificación severa del anillo mitral: reemplazo mitral con prótesis OnX Conform en posición supraanular / Mitral stenosis with severe annular calcification: mitral valve replacement with an OnX Conform prosthesis in a supra annular position

Abstract A 68-year-old man previously subjected to radiotherapy had a prior aortic valve replacement due de radiation induced calcification of the aortic valve. Presently the patient developed severe calcification of the mitral valve ring leading to critical mitral valve stenosis. A supra annular implantation of an On X Conform valve was successfully achieved. The clinical course was uneventful, and the echocardiographic evaluation demonstrated a normal function of the valve. Different alternatives for the surgical management of this complication are discussed.

​A Comparative Study of Changes in Left Ventricular Function after Mitral Valve Replacement in Patients with Severe Rheumatic Mitral Regurgitation with and without Mild Mitral Stenosis

Introduction: Presently off- pump CABG has proved itself tobe a safe, cheaper and effective alternative of on- pump CABG.However, it requires manipulation, displacement, positioning& mechanical stabilization of the heart during grafting whichmay cause haemodynamic alteration. Study was done withthe objective of finding out the changes in Central VenousPressure (CVP); Mean Arterial Pressure (MAP); MeanPulmonary Arterial Pressure (MPAP); Right Ventricular EndDiastolic Pressure (RVEDP) & Left Ventricular End DiastolicPressure (LVEDP) while grafting the anterior, lateral &inferior surfaces of heart during off-pump CABG.Material and methods: Over one year time, 50 patients withLVEF ≥40%, undergoing off-pump CABG were monitoredfor the above parameters at various stages of their operation,namely:- 1. During manipulation & shunt introduction,2.During anastomosis without shunt, 3.During anastomosiswith shunt & 4.After anastomosis; while grafting the anterior,lateral & inferior surfaces of heart. These results werecompared with the baseline values of CVP, MAP, MPAP,RVEDP & LVEDP, to look for statistical significance.Results: During manipulation & shunt introduction; CVP(mmHg) significantly increased during Ramus grafting - 12±1.8(p<0.047); and also during OM grafting – 12.6±1.9 (p<0.045),when compared to a baseline value of 9±1.8. The MAP(mmHg) was significantly decreased during manipulation &shunt introduction in Diagonals - 70±5.8 (p<0.046), Ramus- 70±5.8 (p<0.048), OMs - 65±5.8 (p<0.028) & in the Rightterritory - 69±5.9 (p<0.032); as compared with baselineMAP of 76±11.7. During anastomosis without shunt also, theMAP(mmHg) significantly decreased while grafting LAD- 70±3.8 (p<0.048), Diagonals - 68±3.8 (p<0.039), OMs –71.8±4.8 (p<0.039) & Right sided arteries 70.8±4.6 (p<0.039),as compared with baseline MAP values. The MPAP(mmHg)was significantly increased – 18.3±3.7 (p<0.047) as comparedto the baseline value of 16±2.4 during manipulation & shuntintroduction in the OMs.Conclusion: During OPCABG there will be significantalterations in haemodynamics mostly due to mobilizationof the heart, which is necessary to visualise the targetvessels properly & stabilisation of the concerned areawith stabiliser. However, by observing the haemodynamicvariations constantly & by making necessary mechanical &pharmacological adjustments, unnecessary conversion to Onpump technique can be avoided.

Clinical study of Perioperative Use of Levosimendan in Patients Undergoing Heart Valve Replacement

Objective To investigate the clinical effect of levosimendan in perioperative aortic and/or mitral valvereplacement. Methods Patients undergoing open heart aortic and/or mitral valve replacement in our hospitalfrom January 2018 to December 2019 were enrolled. 45 patients in the control group received routineperioperative treatment based on dopamine, while 45 patients in the research group received continuousperioperative administration of levosimendan injection for 24h on the basis of routine treatment. The leftventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd) and left ventricular end-systolicdiameter (LVDs) were evaluated by color doppler echocardiography before and one week after surgery.Postoperative mechanical ventilation weaning time, length of ICU stays, number of vasoactive drugs used andwithdrawal time; indexes of liver and kidney function before and on the day after surgery to 10 days after surgery;use of in vitro support techniques such as aortic balloon pulsation (IABP), continuous renal replacement therapy(CRRT) and extracorporeal membrane oxygenation (ECMO) within 5 days of perioperative period. Results Theimprovement of LVDs and LVEF in the study group using levosimendan one week after the operation wassignificantly better than that in the control group (P value was 0.013 and 0.001, respectively), and fewer kinds ofvasoactive drugs were needed (P<0.001), and the risk of postoperative AKI in the study group was significantlylower than that in the control group (P=0.047). Conclusion The perioperative use of levosimendan can effectivelypromote the recovery of cardiac systolic function and reduce the risk of postoperative AKI.

Metal Allergy in Cardiovascular Surgery : a Case Report / 日本心臓血管外科学会雑誌

We present a successful case of a patient with multiple metal allergy—cobalt, nickel, chromium, and zinc—who had a past history of systemic metal dermatitis. He was a 58-year-old man who complained of exertional chest discomfort. After admission, he had a fever and his blood culture was positive with methicillin-sensitive Staphylococcus aureus. Three days later, multiple micro cerebral infraction was detected in magnetic resonance imaging. After an improvement of inflammatory reaction, he was transferred to our facility for cardiac examination. Moderate mitral regurgitation due to valve perforation and multiple coronary vessel stenosis were detected. Mitral valve replacement and coronary artery bypass grafting were planned to perform. We chose surgical materials based on a preoperative epicutaneous (patch) test and his clinical course was uneventful without any allergic reaction. Metal contact allergy is an important issue in cardiovascular surgery. A collaboration with dermatologists is essential for the preparation of surgical materials.

A Case in Which Mitral Valve Replacement Was Performed for Recurrent Severe Mitral Regurgitation by Single Leaflet Device Attachment (SLDA) after MitraClip / 日本心臓血管外科学会雑誌

After a MitraClip was implanted for mitral regurgitation (MR), we experienced a case in which mitral valve replacement was performed for recurrent severe MR because of a detached MitraClip. The case was an 82-year-old woman. The MitraClip was implanted for severe MR and regurgitation was controlled to a mild level, but one month after the operation, symptoms of heart failure appeared, and single leaflet device attachment (SLDA) with severe MR was observed on the echocardiogram. As the heart failure symptoms recurred, surgical mitral valve replacement was performed. Because of severe kyphosis, the left atrial approach with a midline sternum incision made it difficult to achieve a good operative field and this was changed intraoperatively to a transseptal approach. The MitraClip was firmly fused with the anterior leaflet A2, so it was judged that removal of the clip was difficult and valve repair was impossible ; it was thus decided to replace the valve. The mark of the MitraClip could be observed on the posterior leaflet, and it appeared to have been inserted for only about 1-2 mm. A bioprosthetic valve was implanted, preserving the posterior leaflet. There were no problems in weaning the patient from cardiopulmonary bypass. The postoperative course was uneventful, and she was discharged on the 14th day after the operation. Valve repair is difficult in a case with a merged SLDA after insertion of a MitraClip, and valve replacement needs to be performed, so it is important to pay attention to the attachment of the MitraClip.

Infective Endocarditis with an Infectious Cerebral Aneurysm Rupture and an Acute Myocardial Infarction / 日本心臓血管外科学会雑誌

A 56-year-old woman was referred to our hospital due to anorexia. An echocardiogram demonstrated severe mitral valve regurgitation and vegetation located on the valve. We diagnosed infective endocarditis and started to treat with antibiotics. During antibiotics treatment, cerebral hemorrhage was caused by rupture of an infectious cerebral aneurysm. She was treated by surgical operation. Waiting for cardiac surgery, she had sudden chest pain. Electrocardiogram examination demonstrated an anterior acute myocardial infarction. Emergency coronary angiogram revealed complete obstruction of the left anterior descending coronary artery. She was successfully treated with thrombus aspiration using a catheter device and stenting. However, she was in cardiogenic shock and her blood pressure could not be maintained with catecholamine and IABP. We performed emergency mitral valve replacement. After surgery, the circulation dynamics improved and she was discharged from the hospital.

Clinical research on radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility, safety and effectiveness of radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery. Methods    The clinical data of 107 patients with rheumatic mitral disease and atrial fibrillation who underwent mitral valve replacement and radiofrequency ablation at the same time in our hospital from January 2014 to October 2018 were retrospectively analyzed. The patients were divided into two groups: a totally thoracoscopic surgery group (n=51, including 20 males and 31 females, aged 50.57±5.24 years) and a median sternotomy group (n=56, including 21 males and 35 females, aged 52.12±5.59 years) according to the surgical methods. The preoperative, intraoperative and postoperative data of the patients were compared. Results    All operations were successfully completed without death. In terms of bleeding volume, drainage volume, ventilator-assisted breathing time, hospital stay and incision length, the totally thoracoscopic surgery group was better than the median sternotomy group, and the difference was statistically significant (P<0.05). The cardiopulmonary bypass time and radiofrequency ablation time in the totally thoracoscopic surgery group were longer than those in the median sternotomy group (P<0.05). There was no significant difference in the operation time, aortic occlusion time, postoperative complications, left ventricular ejection fraction, left atrial diameter and sinus rhythm maintenance between the two groups (P>0.05). There was no atrioventricular block, pulmonary vein stenosis, atrioesophageal fistula, coronary artery injury, stroke or hemorrhage during the follow-up. Conclusion    Radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery is safe and effective, and it is worthy of clinical application.

Síndrome de Takotsubo con disfunción grave de ventrículo izquierdo en el postoperatorio de reemplazo valvular mitral / Postoperative Takotsubo syndrome with severe left ventricular dysfunction following mitral valve replacement

RESUMEN El síndrome de Takotsubo, descrito por vez primera en Japón a fines de 1989 y principios de 1990, caracteriza un conjunto de pacientes con discinesia apical transitoria y conservación de la contractilidad hacia la base del ventrículo izquierdo, que recuerda la forma de la vasija usada por los pescadores para atrapar pulpos. Habitualmente se observa en situaciones que impliquen elevación de catecolaminas y su cuadro clínico es similar al de un infarto agudo de miocardio. El caso que se presenta ocurrió, sorprendentemente, en el postoperatorio de una cirugía cardiovascular y probablemente sea el primero encontrado en Cuba en esta circunstancia: isquemia perioperatoria tras reemplazo valvular mitral, que se recuperó en aproximadamente 72 horas, aunque su recuperación total fue más tardía. Se muestran las imágenes angiográficas.

ABSTRACT Takotsubo syndrome was first described in Japan in late 1989 and early 1990 and featured a group of patients with transient apical dyskinesia and preservation of basal left-ventricular contractility, which resembled the vessel used by fishermen to catch octopus. It is usually seen in situations involving catecholamine release and its clinical picture mimics that of acute myocardial infarction. The case presented occurs, surprisingly, in the postoperative period of cardiovascular surgery and is probably the first one found in this circumstance in Cuba: perioperative ischemia after mitral valve replacement, which recovered within nearly 72 hours, although complete recovery occurred later. Angiographic images are shown.

Aortic dissection after mitral valve replacement: the role of intraoperative echocardiography in this diagnosis / Dissecção de aorta pós-troca valvar mitral: o papel da ecocardiografia intraoperatória no diagnóstico

Abstract According to the most recent guidelines, the use of intraoperative transesophageal echocardiography in valvular surgeries is well established, as well as its use in the diagnosis, management, and rescue of perioperative complications. The aim of this case report is to illustrate a condition in which its intraoperative use had a positive influence on the outcome.

Resumo O uso da ecocardiografia transesofágica no intraoperatório em cirurgias valvulares é bem estabelecido de acordo com os guidelines mais recentes, assim como o seu uso no diagnóstico, manuseio e resgate de complicações perioperatórias. O objetivo deste relato de caso é ilustrar uma situação em que o seu uso no intraoperatório influenciou de maneira positiva o seu desfecho.

A Case of Mitral Valve Replacement Complicated with Essential Thrombocythemia Preoperatively Interrupting Hydroxycarbamide / 日本心臓血管外科学会雑誌

Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by thrombocytosis and malfunction of platelets. Both thrombosis and bleeding due to thrombocytosis may occur. An 81-year-old female patient complicated with ET underwent mitral valve replacement using a bioprosthetic valve due to severe mitral regurgitation. She had been diagnosed and treated with the hydroxycarbamide for ET. The hydroxycarbamide had been interrupted 14 days before the surgery, to prevent infection and delayed wound healing. At hospitalization for surgery, her platelet count rose to 1,290,000/μl from 790,000/μl. Readministration of a half dose of the hydroxycarbamide lowered the platelets to her original level. During the operation, more heparin was necessary to control activated coagulation time for cardiopulmonary bypass. She was discharged unaffectedly on 25 POD.

Progress and prospect of robotic cardiac surgery / 中国胸心血管外科临床杂志

@#Minimally invasive cardiac surgeries are the trend in the future. Among them, robotic cardiac surgery is the latest iteration with several key-hole incision, 3-dimentional visualization, and articulated instrumentation of 7 degree of ergonomic freedom for those complex procedures in the heart. In particular, robotic mitral valve surgery, as well as coronary artery bypass grafting, has evolved over the last decade and become the preferred method at certain specialized centers worldwide because of excellent results. Other cardiac procedures are in various stages of evolution. Stepwise innovation of robotic technology will continue to make robotic operations simpler, more efficient, and less invasive, which will encourage more surgeons to take up this technology and extend the benefits of robotic surgery to a larger patient population.

Incidence of reexploration in cardiac surgery under cardiopulmonary bypass at Government Mohan Kumaramangalam Medical College Hospital, Salem

Background: Cardiac Surgery being the most modern and conceptualized surgery which involves cardiopulmonary bypass Clotting Mechanism, Temperature Control, Hemodilution, and Cardioplegic arrest, etc. The failure of any of these mechanisms ends up in a cascading effect of morbidity and mortality of the patients. The aim of the study: The present study was primarily undertaken to study the incidence off Reexploration in Cardiac Surgery among patients subjected to cardiopulmonary bypass, thereby identifying the factors contributing to Reexploration and adopting suitable measures to reduce the incidence of Reexploration. Materials and methods: Totally 25 patients who underwent cardiac surgery under cardiopulmonary bypass Department of Cardio-Thoracic Surgery, Government Mohan Kumaramangalam Medical College Hospital, Salem. Patients who had a problem of bleeding underwent Reexploration. Patients included in the study belonged to both sexes and age groups varying from 11 to 68 years. The patients were subjected to routine investigations. Results: It was as high as 25% among the patient belonging to three different age groups (20-30), (40-50) and (50-60). The incidence of Reexploration was 58.3% (14/24) among patients who were CPB time exceeded 120 minutes. The overall incidence of Reexploration following open heart surgery was 1.38% (7/25). Among the patients to underwent Reexploration. Patients who underwent open Heart Surgery accounted for 29.16% (7/25) of patients. The incidence of Mortality in this group Pon. A. Rajarajan. Incidence of reexploration in cardiac surgery under cardiopulmonary bypass at Government Mohan Kumaramangalam Medical College Hospital, Salem. IAIM, 2019; 6(4): 20-25. Page 21 was 28.57% (2/7) of patients. Among the 7 patients who had Reexploration 71.4% (5/7 of patients had an uneventful course after Reexploration). 7 Patients who had valve replacement surgery accounted for among the total of 25 patients who had an undergone Reexploration accounting for 29.1% of all cases of Reexploration. 71.4% (5/7) who had undergone Mitral Valve replacement patients accounted for 71.4% (5/7) of Reexploration. Aortic valve replacement patients accounted for 14.2% (1/7). Double Valve replacement patients accounted for 14.2% (1/7). Overall Mortality following Reexploration in this group was 71.42% (5/7). 7 Patients who had a Reexploration after Valve replacement Surgery 28.5% (2/7) of the patients were undergoing Mitral Valve Replacement for Restenosis. One patient who was Reexplored for Post-operative bleeding had a Left Ventricle Free Wall rupture following Mitral Valve Replacement. Conclusion: Attention towards meticulous hemostasis prior to closure is Mandatory. A sound surgical technique will reduce the incidence of bleeding from sites of Cannulation and Anastomosis. Adoption OFF PUMP CABG has shown to reduce the incidence of postoperative bleeding and Morbidity when compare to ON PUMPCABG.

Early and mid-term postoperative comparison of left ventricular structure and function between the mitral repair and replacement in patients with mitral regurgitation / 中华胸心血管外科杂志

Objective@#To compare the early and mid-term postoperative changes of left ventricular structure and function beteen mitral repair and replacement in patients with mitral regurgitation.@*Methods@#100 patients with degenerative mitral regurgitation underwent mitral valve replacement and mitral repair from January 2008 to January 2018 were retrospectively studyed. Of them, 46 patients underwent mitral repair and(repair group) 54 patients underwent mitral valve replacement(replacement group). The results of color Doppler echocardiography before, one week after, 12 months after and 24-36 months after operation were collected. Left atrial diameter(LAD), left ventricular end diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD) were selected to evaluate left ventricular structure, fraction shortening(FS)、left ventricular stroke volume( SV )and left ventricular ejection fraction(LVEF) to evaluate left ventricular function. The data were analyzed by SPSS 22.0.@*Results@#In left ventricular structural parameters, LAD, LVEDD and LVESD in mitral repair group and replacement group were significantly improved compared with those before operation(P<0.05). There was no significant difference in LAD, LVEDD and LVESD between the two groups at 12 months after operation(P>0.05). There were significant differences in LAD(42.26 mm vs 47.15 mm), LVEDD(52.97 mm vs 60.18 mm) and LVESD(31.34 mm vs 34.82 mm) between the two groups at 24-36 months of follow-up(P<0.05). Among the left ventricular function indicators, the early and mid-term SV of the two groups were significantly improved compared with that of the preoperative group(P<0.05). LVEF(0.64 vs 0.59、0.64 vs 0.58)was significantly improved in the 12 and 24-36 months after the operation, and FS(36.18% vs 31.47%) was significantly different in the 24-36 months after the operation(P<0.05).@*Conclusion@#Mitral repair has high technical requirements and long operation time, but it has obvious advantages over mitral valve replacement in maintaining left ventricular structure and function in the middle and late period after operation.

Early and mid-term postoperative comparison of left ventricular structure and function between the mitral repair and replacement in patients with mitral regurgitation / 中华胸心血管外科杂志

Objective To compare the early and mid-term postoperative changes of left ventricular structure and function beteen mitral repair and replacement in patients with mitral regurgitation. Methods 100 patients with degenerative mitral re-gurgitation underwent mitral valve replacement and mitral repair from January 2008 to January 2018 were retrospectively stud-yed. Of them, 46 patients underwent mitral repair and(repair group) 54 patients underwent mitral valve replacement(replace-ment group) . The results of color Doppler echocardiography before, one week after, 12 months after and 24-36 months after operation were collected. Left atrial diameter( LAD) , left ventricular end diastolic diameter( LVEDD) and left ventricular end systolic diameter(LVESD) were selected to evaluate left ventricular structure, fraction shortening(FS)、left ventricular stroke volume( SV )and left ventricular ejection fraction(LVEF) to evaluate left ventricular function. The data were analyzed by SPSS 22. 0. Results In left ventricular structural parameters, LAD, LVEDD and LVESD in mitral repair group and replace-ment group were significantly improved compared with those before operation(P<0. 05). There was no significant difference in LAD, LVEDD and LVESD between the two groups at 12 months after operation(P>0. 05). There were significant differences in LAD(42. 26 mm vs 47. 15 mm), LVEDD(52. 97 mm vs 60. 18 mm) and LVESD(31. 34 mm vs 34. 82 mm) between the two groups at 24-36 months of follow-up(P<0. 05). Among the left ventricular function indicators, the early and mid-term SV of the two groups were significantly improved compared with that of the preoperative group(P<0. 05). LVEF(0. 64 vs 0. 59、0. 64 vs 0. 58)was significantly improved in the 12 and 24-36 months after the operation, and FS(36. 18％ vs 31. 47％) was significantly different in the 24-36 months after the operation(P<0. 05). Conclusion Mitral repair has high technical requirements and long operation time, but it has obvious advantages over mitral valve replacement in maintaining left ventricular structure and function in the middle and late period after operation.

Treatment strategy of mechanical hemolysis after mitral valve repair / 医学研究生学报

Objective　In recent yaers, mitral valve repair has been widely used in the surgical treatment of congenital and secondary mitral valve lesions. To investigate the mechanism and treatment strategy of mechanical hemolysis after mitral valve repair.　Methods　A total of 451 consecutive patients registrated in general hospital of southern theatre command who underwent mitral valve repair surgery between August 2010 and June 2018,of whom 16(3.5%) had complicated mechanical hemolysis(hemoglobinuria, jaundice, anemia), were retrospectively analyzed. Echocardiographic examination showed that there were 3 cases of mild mitral regurgitation(MR), 9 cases of moderate MR and 4 cases of severe MR, among which 75% of mitral regurgitation flow were rapid regurgitant jets (Vmax>4m/s). According to the treatment strategy,all cases were divided into two groups: the aggressive reoperation group（n=10）,patients received re-repair procedures within 1 week after hemolysis diagnosis. The conservative treatment group(n=6), patients received symptomatic treatment of hemodialysis, blood transfusion, diuresis, alkalization of urine, liver protection and oral metoprolol et al. All patients were followed up for 2 to 36 months, with an average (16±7.5) months, and the postoperative echocardiographic results, hemolysis symptom improvement and cardiac function were compared.　Results　No death occurred in the two groups after operation. The symptoms of patients in the aggressive reoperation group receded rapidly and discharged from hospital. 4 patients in the conservative treatment group received reoperation 3~11 weeks after surgery due to poor treatment effect (1 patient underwent re-repair and 3 patients underwent replacement), the other 2 patients received long-term conservative treatment. The cardiac function of the patients undergoing reoperation was maintained at level I~II. Echocardiographic examination showed that mild MR(n=10), mild~moderate MR(n=3), and no recurrence of mechanical hemolysis. Two patients with long-term conservative treatment, mild~moderate anemia, urinogen +~++, moderate MR, cardiac function at level II, were in a subclinical hemolytic state.　Conclusion　Mechanical hemolysis frequently occurs immediately or soon after mitral valve repair. Hemoglobinuria, jaundice, anemia and postoper echocardiography found the mitral regurgitant flow with high-shear stress, these helpful to the diagnosis. Surgery is an important factor affecting hemolysis. Hemolysis can be a sign of surgical failure, re-repair operation is the best treatment as soon as possible after the hemolysis has been diagnosed.Conservative treatment is not the priority choice.