Abstract： Objective To summarize our experience and clinical outcomes of preservation of posterior leaflet and subvalvular structures in mitral valve replacement（MVR）. Methods We retrospectively analyzed the clinical data of 1 035 patients who underwent MVR in Beijing An Zhen Hospital from January 2006 to March 2011. There were 562 male patients and 473 female patients with their age of 37-78（53.84±13.13）years old. There were 712 patients with rheumatic valvular heart disease and 323 patients with degenerative valve disease, 389 patients with mitral stenosis and 646 patients with mitral regurgitation. No patient had coronary artery disease in this group. For 457 patients in non-preservation group, bothleaflets and corresponding chordal excision was performed, while for 578 patients in preservation group, posterior leafletand subvalvular structures were preserved. There was no statistical difference in demographic and preoperative clinical characteristics between the two groups. Postoperative mortality and morbidity, and left ventricular size and function were compared between the two groups. Results There was no statistical difference in postoperative mortality（2.63% vs. 1.21%, P =0.091）and morbidity （8.53% vs. 7.44%, P=0.519）between the non-preservation group and preservation group, except that the rate of left ventricular rupture of non-preservation group was significantly higher than that of preservation group（1.09% vs. 0.00%, P=0.012）. The average left ventricular end-diastolic dimension （LVEDD）measured by echocardiography 6 months after surgery decreased in both groups, but there was no statistical difference between the two groups. The average left ventricular ejection fraction (LVEF) 6 months after surgery was significantly improved compared with preoperative average LVEF in both groups. The average LVEF 6 months after surgery in patients with mitral regurgitation in the preservation group was significantly higher than that in non-preservation group （56.00%±3.47% vs. 53.00%±3.13%，P =0.000）, and there was no statistical difference in the average LVEF 6 months after surgery in patients with mitral stenosis between the two groups（57.00%±5.58% vs. 56.00%±4.79%，P =0.066）. Conclusion Preservation of posterior leaflet and subvalvular structures in MVR is a safe and effective surgical technique to reduce the risk of left ventricle rupture and improve postoperative left ventricular function．
【摘要】 目的 觀察原發性高血壓左心室肥厚患者的心律失常情況。 方法 對2000年1月-2009年10月收治的251例原發性高血壓患者進行超聲心動圖及Holter檢查，比較有左心室肥厚（left ventricular hypertrophy，LVH）及無LVH兩組各類心律失常的發生情況。 結果 LVH組各種心律失常的發生率與非LVH組比較，差異有統計學意義（Plt;0.01）。LVH組室性心律失常及復雜性室性心律失常的檢出率為83.33%和51.85%，明顯高于非LVH組（28.67%和9.09%），差異有統計學意義（Plt;0.01）。 結論 高血壓并發LVH與心律失常的發生有一定密切關系。【Abstract】 Objective To analyze the condition of arrhythmia in the patients with primary hypertension combined with left ventricular hypertrophy. Methods A total of 251 patients with primary hypertension from January 2000 to October 2009 were selected. All the patients had undergone the examinations of ultrasonic cardiogram, 12-lead electrocardiogram and Holter test to compare the incidence of arrhythmia between LVH and non-LVH group. Results There were significant differences in the incidences of arrhythmia between the two groups (Plt;0.01). Furthermore, the incidence of ventricular arrhythmias and complexity of ventricular arrhythmias of the patients in LVH group was 83.33% and 51.85% respectively, significantly higher than that in non-LVH group (28.67% and 9.09%; Plt;0.01). Conclusion Primary hypertension combined with LVH is relevant to arrhythmias.
ObjectiveTo investigate the factors influencing myocardial recovery after left ventricular assist device (LVAD) implantation, aiming to identify patient characteristics associated with a higher potential for cardiac recovery and to inform clinical decision-making. MethodsThis retrospective study included consecutive patients with end-stage heart failure who underwent LVAD implantation at our institution between 2021 and June, 2025. Patients were categorized into three groups including a myocardial recovery group, an ongoing LVAD support group, and death group. Based on their postoperative outcomes, demographic, laboratory, and imaging data were compared among the groups. Multivariate logistic regression analysis was performed to identify independent predictors of myocardial recovery. Results A total of 57 patients who received an LVAD were included. Among them, 9 (15.8%) achieved myocardial recovery, 39 (68.4%) remained on LVAD support, and 9 (15.8%) died. Multivariate analysis identified younger age (OR=0.875, P=0.004) and a smaller preoperative left ventricular end-systolic diameter (LVESD) (OR=0.866, P=0.047) as independent predictors of myocardial recovery. Notably, all patients in the recovery group were male and had no prior implantation of an implantable cardioverter-defibrillator/cardiac resynchronization therapy defibrillator. Furthermore, a higher preoperative prealbumin level was significantly associated with survival (OR=1.018, P=0.024). ConclusionYounger age and a smaller preoperative LVESD are key predictors for myocardial recovery following LVAD implantation. Younger patients with a smaller LVESD exhibit a greater potential for functional recovery. Preoperative nutritional status, as indicated by prealbumin levels, may be a predictor of mortality.
Abstract: Objective To evaluate the treatment efficacy of post-infarction left ventricular pseudo-aneurysm (LVPA) through surgical procedure, and explore the diagnosis and differential diagnosis details of LVPA. Methods Between May 1993 and July 2007, 7 cases were diagnosed through echocardiography aided with left ventriculography or multi-sliced computer tomography (MSCT) or magnetic resonance imaging (MRI); 6 cases with LVPA were surgically treated through different procedure that included direct closure, cut and patching or cut and sandwiching procedure choose according to its location, anatomical morphology, and comorbidity; accompanied diseases were treated by coronary artery bypass grafting(CABG) procedure. Results Six cases were diagnosed before surgery, and 1 case was diagnosed during the surgical procedure. One died from the cardiac tamponade due to rupture of LVPA before the surgical procedure, so the inhospital mortality was 14.3%（1/7）. There was no operative death. With the follow-up from 2 months to 13 years of the 6 operational survivors, 1 case died from cardiac rupture and pericardial tamponade 4 years after the repair procedure. Of the 5 surviving LVPA, the left ventricular ejection fraction(LVEF) values were from 43% to 52%, and 3 cases were in New York Heart Association (NYHA) class Ⅰ, and 2 cases were in NYHA class Ⅱ. Conclusion Echocardiography, aided with left ventriculography or MSCT or MRI, is an effective measure for diagnosis of LVPA. Surgical procedure is an effective measure to treat LVPA,but different surgical procedures, accompanied with homeochronous CABG procedure,should be adopted to deal with LVPA according its location, anatomical morphology, and accompanied deformity. The perioperative and mid-long term efficacy were good for the surgical treatment of LVPA, but it is imperative to pay attention to prevention of the recurrence and the late rupture of repaired LVPA.
Left ventricular outflow tract obstruction (LVOTO) in Ebstein's anomaly is a rare complication, and LVOTO related to surgery is rarer. We present a 46 years old female patient who was dignosed with Ebstein's anomaly, then suffered from cardiac arrest because of LVOTO secondary to cone reconstruction in ICU.
ObjectiveTo summarize the pathological characteristics of primary left ventricular tumors and their influence on surgical treatment.MethodsThe clinical data of 32 patients with primary left ventricular tumor in Fuwai Hospital from January 2008 to March 2019 were retrospectively analyzed, including 17 males and 15 females with an average age of 33.88±17.89 years. The impact of different types of left ventricular tumor pathology on the surgical outcome was analyzed.ResultsThirty-two patients with primary left ventricular tumors underwent surgery. Postoperative pathological biopsy results revealed benign tumor in 31 patients, including myxoma in 10 patients, lipomas in 7 patients, fibroma in 4 patients, hemangioma in 3 patients, rhabdomyoma in 2 patients, cyst in 2 patients, schwannoma in 1 patient, papillary fibroelastoma in 1 patient, cavernous hyperplasia of valvular lymphatic vessels in 1 patient. There was 1 patient of carcinoid (low-grade malignant tumor). Thirty patients underwent tumor resection surgery under hypothermic anesthesia and cardiopulmonary bypass followed by cardiac arrest while 2 patients without cardiopulmonary bypass. Nine patients received partial resection of the tumor, including lipomas in 6 patients, rhabdomyoma in 2 patients, schwannoma in 1 patient. Twenty-three patients received complete resection of the tumor. There were no in-hospital deaths, bleeding, secondary thoracotomy, low cardiac output, renal failure, postoperative embolism or other surgical complications. All the patients were normal before they were discharged out of the hospital. Their average postoperative hospital stay was 8.1±2.7 d. Within 6 months after the surgery, all 32 patients returned to the hospital for reexamination, and ultrasound results were all normal. Afterwards, the patients were followed up by telephone or in an outpatient clinic, and 3 patients were lost. The follow-up rate was 90.63%. During the follow-up of 3-120 (61.4±38.5) months, among the 9 patients whose tumors were partially resection, 2 patients recurred. One patient with schwannoma recurred 30 months after the surgery, and in the other patient lipomas grew 15 months later which resulted in massive regurgitation of the mitral valve.ConclusionSurgical resection is the first choice for the treatment of left ventricular benign tumors. For malignant left ventricular tumors, it is necessary to be cautious, and the surgical risk needs to be carefully evaluated. Most of the primary left ventricular tumors need to be operated as soon as possible. A surgeon should develop different surgical strategies according to different pathological types of tumors.
