Objective To evaluate the feasibility of strent-graft with Chimney technique in thoracic endovascular aortic repair (TEVAR) of thoracic aortic dissection left subclavian artery (LSA) disease and left common carotid artery (LCCA) disease without good landing zone. Methods A total of 21 patients with thoracic aortic diseases complicated by in-sufficient proximal anchoring area,who were presented in our hospital in recent years,were selected in this study. The clini-cal data were retrospectively analyzed. The thoracic aortic diseases included aortic dissection ( n=11), aortic pseudoaneurysm (n=2), aortic aneurysm(n=1) and penetrating ulcer(n=7). Among all 21 patients,lesion was located in distal to LSA in 18 pa-tients with distance to LSA anchoring less than15 mm,and the lesion was located between the LSA and LCCA in the rest 3 patients.Thoracic aortic stent-graft placement was carried out.The ostium of LSA was intentionally and completely cov-ered by thoracic aortic stent-graft and left subclavian artery or left internal carotid artery stent-graft placement was subse-quently performed. The patients were observed for symptoms of cerebral and upper limb ischemia. The postoperative com-plications such as endoleak and the patency of LSA were assessed with angiography. Results Thoracic aortic stent-graft placement was suceessfully carried out in all 21 patients. In addition,one“Chimney”stent was properly implanted in LSA or LICA in each patient. After the procedure,no complications of nervous system or severe ischemia of upper extremity was observed. Follow-up examinations between to 38 months after the treatment revealed that the aortic stent-graft remained in stable condition without type I endoleak. Meanwhile the blood flow in“chinney”stent was unobstructed. Conclusion Chimney technique can expand the applicability of TSGP with high tolerance. Chimney technique expand the applicability of TEVAR for patients with challenging anatomy. It is a safe,effective and microinvasive method to treat thoracic aortic lesions.

Objective:To investigate the clinical effect of "standardized 4 steps" in rheumatic mitral valve repair.Methods:We retrospectively analyze the clinical data of 136 rheumatic mitral valve disease patients undergoing mitral valve repair with "standardized 4 steps" from June 2016 to July 2019 and investigate its clinical outcome. The clinical outcome was compared with those of patients undergoing rheumatic mitral valve replacement.Results:The perioperative mortality was 2.94% in patients with mitral valve repair. Compared with preoperative period, left atrial diameter was significantly reduced and the early diastolic blood flow velocity across mitral valve(E peak) was significantly decreased at 1-week postoperative and follow-up period. The elimination rate of atrial fibrillation was 80.7% during follow-up period. The early clinical outcome and related complications had no difference between mitral repair group and mitral valve replacement group. The main echocardiographic indexes in two groups also had no statistical significance.Conclusion:The early clinical outcome of rheumatic mitral valve repair with "standardized 4 steps" is satisfactory. Rheumatic mitral valve repair with "standardized 4 steps" is feasible, safe and effective.