From March 1995 to May 2002, at Hanoi Military Hospital N.108,on 98 patients taken surgical commissurotomy for mitral valve, pulmonary arterial pressure declined from 40,7± 12,7 mmHg before surgery to 29,6 ± 8,2mmHg after surgery, right ventricular pressure from 38,1 ± 11,1mmHg to 29,4 ± 8,4mmHg and left auricular pressure from 32,2 ± 8,6mmHg to 23,2± 7,1mmHg. This had demonstrated very good results of mitral valve commissurotomy, in l to improve hemodynamic state in pulmonary arterial pressure and heart chamber pressure
Pulmonary Wedge Pressure ; heart ; Mitral Valve ; surgery ;

Tetralogy of Fallot with absent pulmonary valve is a very rare form of congenital heart disease with various clinical presentations. We experienced a 25-year-old female of severe pulmonary regurgitation due to absent pulmonary valve who had a history of open heart surgery for tetralogy of Fallot and review the literatures.
Adult ; Female ; Heart Defects, Congenital ; Humans ; Pulmonary Valve Insufficiency* ; Pulmonary Valve* ; Tetralogy of Fallot ; Thoracic Surgery

98 patients were operated surgical commissurotomy in the No 108 Military Hospital from March 1995 to May 2000. All patients were performed Doppler ultrasonography pre- and post-operation. All patients were received surgical commissurotomy by Tubs. Hemodynamics was changed with satisfactory results after surgical commissurotomy the pulmonary arteries pressure down from 50.4  15.5 to 36.6  7.9 mmHg; MaxPG (mmHg) down from 22.1  7.6 to 12.3  3.3 and mean PG (mmHg) also down from 13.5  4.8 to 6.9  4.5. For right indication and contraindication in surgical intervention, as well as prognosis of postoperative patient's life, the evaluation of hemodynamic indexes are necessary, in which Doppler ultrasound plays an importance role in assessing the pre- and postoperative results
Hemodynamics ; Pulmonary Artery ; heart ; Mitral Valve ; surgery ; Ultrasonography

Anesthesia ; Catheterization ; methods ; Female ; Humans ; Infant, Newborn ; Male ; Pulmonary Atresia ; surgery ; Pulmonary Valve Stenosis ; surgery

OBJECTIVETo summarize the experience on auto-pulmonary transplantation (Ross procedure) treating with congenital aortic disease.

METHODSFrom October 1994 to November 2003, 20 cases of Ross procedure were performed to treat with congenital aortic disease, Male: 15 cases; Female: 5 cases; age: 25 years;

DIAGNOSIScongenital heart disease (CHD), aortic abnormalities: 12 cases; aortic valve prolapse: 5 cases; aortic valve hypogenesis: 3 cases; combined with subacute bacterial endocarditis (SBE): 4 cases, and ventricle septal defect (VSD): 2 cases; UCG showed aortic stenosis(AS) and/or aortic insufficience (AI) (moderate to severe), Left ventricle diastole diameter (LVDD): (60.51 +/- 11.87) mm, the grade pressure across aortic valve: (27.04 +/- 6.80) mmHg, heart function (NYHA): Class II: 13 cases; Class III: 3 cases; all cases were performed under CPB and moderate hypothermia, the operation procedure was following: (1) taking off auto-pulmonary artery valve; (2) removing dysfunctional aortic valve and auto-transplantation of pulmonary valve on aortic root; (3) putting a pulmonary homograft to rebuild right ventricular outflow tract.

RESULTSThe mortality was 0 during stay at hospital, aortic valve function were all normal, LVDD decreased significantly (t = 3.4007, P = 0.0008), the grade pressure across aortic valve was in normal limitation, (6.8 +/- 0.19) mmHg. Follow-up showed heart function was in Class I (NYHA), aortic and pulmonary valve function was very well.

CONCLUSIONRoss procedure is a kind of effective alterative operation for treating with congenital aortic valve disease, with good short and middle term results.

Adolescent ; Adult ; Aortic Valve Insufficiency ; surgery ; Aortic Valve Prolapse ; surgery ; Aortic Valve Stenosis ; surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Pulmonary Valve ; transplantation ; Transplantation, Autologous

OBJECTIVEThe aim of this study was to identify the long-term character of the domestic bileaflet mechanical valve in the chronic implanted sheep model and to evaluate the potential value of the modal.

METHODSSix adult sheep underwent implanted mechanical bileaflet valve in pulmonary position under the cardio-pulmonary bypass with beating heart. The chronic implanted sheep model was built up and observed in the respects of a long-term survival, function of prosthesis and pathological specimen.

RESULTSSix adult sheep survived with good condition after operation. The average survival period of six sheep was (221 +/- 208) days. Two sheep were postoperatively sacrificed in 41 and 71 days, respectively. The necropsy revealed normal valve function without thrombosis, periprosthetic leakage and overgrowth of fibrous tissue. One sheep died from dysfunction of prosthetic valve at the postoperative 196 days. The reason was the prosthetic thrombosis with slight overgrowth of fibrous tissue in periprosthesis. The other two sheep died from severe anemia at the postoperative 196 days and 234 days, and the autopsy revealed no abnormal finding else. And one remained to survive with good condition up to now (over 617 days) and was checked by Doppler echocardiogram twice at the postoperative 438 days and 479 days, respectively. The results showed normal function of the bileaflet valve in pulmonary position.

CONCLUSIONThe long-term good effects would be achieved by using the implanted new domestic bileaflet valve in pulmonary position of sheep.

Animals ; Heart Valve Prosthesis Implantation ; methods ; Male ; Models, Animal ; Pulmonary Valve ; surgery ; Sheep

BACKGROUNDPulmonary regurgitation leads to progressive right ventricular dysfunction, susceptibility to arrhythmias, and sudden cardiac death. Percutaneous valve replacement has been developed in recent years, providing patients with an alternative option. Percutaneous pulmonary valve replacement has been recently introduced into clinical practice. The goal of this study was to evaluate the feasibility of percutaneous valve stent insertion to correct the pulmonary regurgitation in sheep using a cup-shaped valve stent.

METHODSPulmonary regurgitation was created by percutaneous cylindrical stent insertion in native pulmonary annulus of 8 sheep. One month after the initial procedure, the sheep with previous cylindrical stent implanted underwent the same implantation procedure of pulmonary valve stent. The valve stent consisted of a cup-shaped stent and pericardial valves. Hemodynamic assessments of the bioprosthetic pulmonary valve were obtained by echocardiography at immediately post-implant and at 2 months follow up.

RESULTSSuccessful transcatheter cylindrical stent insertion was performed in 7 sheep but failed in 1 sheep because the cylindrical stent was released to right ventricle outflow tract. After one month the 7 sheep with pulmonary regurgitation underwent valve stent implantation successfully. Echocardiography confirmed the stents were in desired position during the follow-up. No evidence of pulmonary valve insufficiency occurred in any animals. Echocardiography showed all heart function markers were normal.

CONCLUSIONSPercutaneous cylindrical stent insertion to induce significant pulmonary regurgitation in sheep was feasible, simple and reproducible. Percutaneous pulmonary valve stent implantation can reduce pulmonary regurgitation in a sheep model. Further development of animal model and clinical trials are warranted.

Animals ; Feasibility Studies ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Male ; Pulmonary Valve Insufficiency ; surgery ; Sheep

The Ross operation, a procedure of replacement of the diseased aortic valve with an autologous pulmonary valve, has many advantages such as no need for anticoagulation therapy and similar valve function and growth potential as native valves. However secondary aortic disease has emerged as a significant complication and indication for reoperation. We report a 48-year-old woman who had Ross operation in 1997 for a damaged bicuspid aortic valve and severe aortic regurgitation due to subacute bacterial endocarditis complicated by aortic root abscess. In 2009, 12 years later, progressive severe aortic regurgitation with incomplete coaptation and mild dilatation of the aortic root was shown on echocardiography and contrasted CT, while the pulmonary homograft retained normal function. She subsequently underwent aortic valve replacement. Histopathological examination of the explanted neo-aortic valve and neo-arterial wall revealed pannus formation at the nodulus Arantii area of the three valve cusps, ventricularis, and arterialis. The amount of elastic fibres in the neo-aorta media was less than usual for an aorta of this patient's age but was similar to a pulmonary artery. The pathological findings were not different from other studies of specimens removed between 7 to 12 years after Ross operation. However, the pathophysiology and long-term implications of these findings remain debatable. Considering the anatomical and physiological changes induced by the procedure, separate mechanisms for aortic dilatation and regurgitation are worthy of consideration.
Aorta/*pathology ; Aortic Valve/*surgery ; Aortic Valve Insufficiency/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Dilatation, Pathologic ; Heart Valve Diseases/*surgery ; Prostheses and Implants ; Pulmonary Valve/*transplantation

Cardiac Catheterization ; Cardiac Surgical Procedures ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Heart Ventricles/surgery* ; Humans ; Pulmonary Valve/surgery* ; Pulmonary Valve Insufficiency/surgery* ; Treatment Outcome ; Ventricular Outflow Obstruction/surgery*

Recently, surgical outcomes of repair of tetralogy of Fallot (TOF) have improved. For patients with TOF older than 3 months, primary repair has been advocated regardless of symptoms. However, a surgical approach to symptomatic TOF in neonates or very young infants remains elusive. Traditionally, there have been two surgical options for these patients: primary repair versus an initial aortopulmonary shunt followed by repair. Early primary repair provides several advantages, including avoidance of shunt-related complications, early relief of hypoxia, promotion of normal lung development, avoidance of ventricular hypertrophy and fibrosis, and psychological comfort to the family. Because of advances in cardiopulmonary bypass techniques and accumulated experience in neonatal cardiac surgery, primary repair in neonates with TOF has been performed with excellent early outcomes (early mortality<5%), which may be superior to the outcomes of aortopulmonary shunting. A remaining question regarding surgical options is whether shunts can preserve the pulmonary valve annulus for TOF neonates with pulmonary stenosis. Symptomatic neonates and older infants have different anatomies of right ventricular outflow tract (RVOT) obstructions, which in neonates are nearly always caused by a hypoplastic pulmonary valve annulus instead of infundibular obstruction. Therefore, a shunt is less likely to preserve the pulmonary valve annulus than is primary repair. Primary repair of TOF can be performed safely in most symptomatic neonates. Patients who have had primary repair should be closely followed up to evaluate the RVOT pathology and right ventricular function.
Anoxia ; Cardiopulmonary Bypass ; Fibrosis ; Humans ; Hypertrophy ; Infant ; Infant, Newborn* ; Lung ; Pathology ; Pulmonary Atresia* ; Pulmonary Valve ; Pulmonary Valve Stenosis ; Tetralogy of Fallot* ; Thoracic Surgery ; Ventricular Function, Right