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Establishment of mitral regurgitation model by a transapical artificial chordae tendineae implantation device in swines

ObjectiveTo research the procedure for creating an animal model of mitral regurgitation by implanting a device through the apical artificial chordae tendineae, and to assess the stability and dependability of the device. MethodsTwelve large white swines were employed in the experiments. Through a tiny hole in the apex of the heart, the artificial chordae tendineae of the mitral valve was inserted under the guidance of transcardiac ultrasonography. Before, immediately after, and one and three months after surgery, cardiac ultrasonography signs were noted. Results All models were successfully established. During the operation and the follow-up, no swines died. Immediately after surgery, the mitral valve experienced moderate regurgitation. Compared with preoperation, there was a variable increase in the amount of regurgitation and the values of heart diameters at a 3-month follow-up (P<0.05). ConclusionIn off-pump, the technique of pulling the mitral valve leaflets with chordae tendineae implanted transapically under ultrasound guidance can stably and consistently create an animal model of mitral regurgitation.

Surgical Treatments of Post Infarction Ventricular Aneurysm and Mitral Regurgitation

Objective To summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation， thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation （30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003）by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.

Estimation of the number of patients with mitral regurgitation in China

Mitral regurgitation (MR) is the most common heart valve disease. In recent years, the rise of interventional therapy has expanded the indications of interventional treatment for patients with MR, but the epidemiological characteristics of MR (especially the number of patients with MR requiring treatment) in China are still unclear. In this paper, we analyzed and estimated the number of MR patients in China based on three epidemiological studies in Europe and America, and referring to the patients population surveys from Zhongshan Hospital Affiliated to Fudan University, the Second Affiliated Hospital Zhejiang University School of Medicine and Beijing Fuwai Hospital. Our analysis estimated that about 7.5 million patients with MR need intervention in China, including about 5.5 million patients with severe MR.

经房间隔经导管二尖瓣置换术的手术配合及护理三例

二尖瓣成形术治疗二尖瓣反流89例临床分析

目的　总结二尖瓣成形术治疗二尖瓣反流患者的临床经验，分析其疗效。　方法　回顾性分析2007 年1 月至 2011 年 7月中国医科大学附属第一医院采用二尖瓣成形术治疗89 例二尖瓣中重度反流患者的临床资料，其中男 51例，女 38 例；年龄21～64 （48.6±13.6）岁；病程1周～21 年。术前经食管超声心动图及术中探查发现二尖瓣中度反流（Ⅲ级） 40 例，重度反流 （Ⅳ级） 49 例。56例二尖瓣脱垂，脱垂病变累及A2区4例、A3区5例、P2区25例、P3区14例，累及多处8例；其中二尖瓣腱索断裂37例，腱索冗长脱垂19例；瓣环扩大42例。手术方式：前叶腱索转移4 例 ， 前叶人工腱索 6 例 ，前叶裂缝合2例，交界部缝合 6 例 ，后叶矩形切除加 Sliding （滑行） 技术43 例，后叶折叠缝合成形14例，后叶人工腱索12例，缘对缘成形 10 例和心包补片修补瓣叶穿孔 1 例，其中2种以上修复方式9例。全部患者均使用成形环加固瓣环。手术中应用注水试验和食管超声心动图检查评价成形效果。　结果　无围术期死亡。术后心脏超声心动图提示：二尖瓣无反流 （0 级）15 例，微量反流 （Ⅰ级）41 例，轻度反流 （Ⅱ级） 23 例，轻至中度反流 （Ⅲ级）10 例。所有患者均无二尖瓣狭窄。术后随访77例（86.52%），随访时间3～58 （12.3±18.7） 个月。随访期间1例死于脑血管意外；1例行二尖瓣置换术。　结论 综合运用多种二尖瓣成形技术治疗二尖瓣中重度反流，可获得良好的临床疗效。

Surgical Treatment of Mitral Desease Patients Associated with Hypertrophic Obstructive Cardiomyopathy

ObjectiveTo summarize the surgical strategy on treating mitral desease patient associated with hypertrophic obstructive cadiomyopathy (HOCM). MethodsWe retrospectively analyzed the clinical data of 17 patients with HOCM underwent surgical treatment from November 2003 to May 2015 year. There were 10 males and 7 females with a mean age of 42.2±15.5 years ranging from 7-62 years. There were 16 patients underwent modified Morrow procedure and 1 patient underwent modified Konno procedure to relieve the obstruction of left ventricular outflow tract. And different surgical treatment of mitral valve disease was implemented depending on the severity of regurgitation and under monitoring of transesophageal echocardiography. About 2 weeks after the surgery, we performed transthoracic echocardiography to evaluate the effect of operation. ResultsNo hospital death occurred and the surgery obviously improved the symptom and cardiac function in all cases. After surgery, echocardiography revealed that the mean thickness of the ventricular septum statistically decreased (P < 0.0001), the systolic anterior motion disappeared, the outflow track pressure of left ventricle statistically decreased (P < 0.0001), and the peak flow rate of left ventricle statistically decreased. However, there was no statistical difference in the change of the left ventricular ejection fraction(P=0.083). Nine patients with no mitral regurgitation (MR) or mild MR only underwent the unblock of the left ventricular outflow track, the MR decreased to mild or disappeared. Four patients with moderate or severe MR underwent mitral valve repair, and the MR decrease to mild or disappear. There were no complications occurred regarding to prosthesis implantation over the 4 patients underwent mitral valve replacement for infective endocarditis or other causes. ConclusionFor the HOCM patients with mild MR, the unblock of the left ventricular outflow track alone can effectively improve the MR. For those combined with moderate or severe MR, we should choose mitral valve repair or replacement based on individual situation of patient.

Transcatheter edge-to-edge repair (TEER): Past, current and future perspectives

Transcatheter edge-to-edge repair (TEER) originated from surgical edge-to-edge repair. MitraClip is the first mature TEER device, and the TEER based on MitraClip is far ahead of many transcatheter mitral valve repair (TMVr) technologies in terms of safety, effectiveness and popularity, so it is named separately in the latest guidelines. The TEER has the following advantages: consistent with basic medical principles, few implants, precise target, less invasive and repeatable. However, there are also some shortcomings, such as the relatively complex design of transfemoral device, target single and relatively narrow indications. At present, the main clinical data of TEER are mainly from the clinical practice of MitraClip. Based on the three-year outcomes of COAPT study, both 2020 ACC/AHA guideline and 2020 ACC expert consensus decision pathway on the management of mitral regurgitation recommend in patients with chronic heart failure with left ventricular dysfunction and severe mitral regurgitation in nonresponders to medicine treatment. Edward's PASCAL, another TEER device, has two models. Among the domestic TEER devices, the ValveClamp of Hanyu medical technology has many distinct advantages, such as simple operation, large clamping area, high clamping efficiency and no need of X-ray. DragonFly, another domestic TEER device, has also completed its feasibility study. There are five trends of TEER in the future: further expansion of indications, combination with other interventional techniques, repeatable operations, transcatheter mitral valve replacement after TEER, and continuous improvement and innovation of equipment.

Definition of atrial functional mitral regurgitation and feasibility of percutaneous edge-to-edge mitral valve repair in atrial functional mitral regurgitation

Atrial functional mitral regurgitation has been referred to patients with atrial fibrillation related functional mitral regurgitation without left ventricular dysfunction and it has nowadays received remarked attention in structural heart disease field. Significant dilation of mitral annulus and left atrium, insufficient leaflet remodeling, iatrogenic leaflet tethering, reduced annular contractility and increased valve stress by flattened saddle shape of the annulus might be important triggers of atrial functional mitral regurgitation. Recently, several studies indicated that transcatheter edge-to-edge mitral valve repair could be an effective strategy for atrial functional mitral regurgitation. In this review, the definition, mechanism together with efficacy and safety of transcatheter edge-to-edge mitral valve repair in atrial functional mitral regurgitation are discussed.

自体肺动脉瓣-二尖瓣移植术（Ross Ⅱ 手术）治疗小儿二尖瓣反流一例：手术技术并 7 年随访结果

Early outcomes of domestic left ventricular assist device implantation with or without concomitant mitral valvuloplasty

Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device (LVAD) with or without concomitant mitral valvuloplasty (MVP). Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed. The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously, and early outcomes were compared between the two groups. Results There were 4 patients in the LVAD group, all males, aged (43.5±5.9) years, and 13 patients in the LVAD+MVP group, including 10 males and 3 females, aged (46.8±16.7) years. All the patients were successful in concomitant MVP without mitral reguragitation occurrence. Compared with the LVAD group, the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation, but the difference was not statistically different (P>0.05). Pulmonary artery systolic pressure was significantly lower 1 week after operation, as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation (P<0.01). There was no statistically significant difference in blood loss, operation time, cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time, or ICU stay time between the two groups (P>0.05). The differences in 1-month postoperative mortality, acute kidney injury, reoperation, gastrointestinal bleeding, and thrombosis and other complications between the two groups were not statistically significant (P>0.05). Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible, and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.