Patients with severe mitral regurgitation (MR) should undergo surgery when they present symptoms or if asymptomatic when there is objective evidence of left ventricular dysfunction. In this work, we analyze the midter...Patients with severe mitral regurgitation (MR) should undergo surgery when they present symptoms or if asymptomatic when there is objective evidence of left ventricular dysfunction. In this work, we analyze the midterm results of leaflet augmentation in mitral valve repair of rheumatic valves with gluteraldehyde preserved autologous pericardium. Patients and Methods: In our department 48 patients were exposed to mitral valve repair by leaflet augmentation either anterior or posterior beside other technique and all patients supported by flexible annuloplasty ring and followed for five years clinically and by echocardiography. Results: Age of the patients ranging from 12 to 47 years, mean age 25.9 ± 8.9 and there were 12 males (25%) and 36 females (75%) with male to female ratio of 1:3. All patients presented with shortness of breath (100%);with 14 patients were in NYHA class III (29.17%) and 34 patients were in NYHA class IV (70.83%). During follow-up period 5 patients needed reoperation by valve replacement, causes of reoperation were restrictive valve motion in one patient, left atrial thrombus in 1 patient and sever mitral regurgitation in 3 patients. Freedom from reoperation was 87.5%. At 5 years, (92.9%) were in New York Heart Association functional class I, three patients (7.1%) were in class II. Echocardiography at follow-up showed satisfactory mitral valve function. Conclusion: leaflet augmentation is a simple and reproducible method of valve repair for rheumatic MR with good midterm result.展开更多
Background: Tracheobronchial disruption as a result of blunt thoracic trauma is a rare entity and only clinically serious lesions come to our notice, which can be life-threatening and need prompt recognition and treat...Background: Tracheobronchial disruption as a result of blunt thoracic trauma is a rare entity and only clinically serious lesions come to our notice, which can be life-threatening and need prompt recognition and treatment. Objectives: To review the authors’ experience with tracheobronchial injuries to emphasize the need for prompt diagnosis and treatment to avoid lethal complications including severe hypoxic organ failure, sepsis, mediastinitis and bronchopleural fistula. Patients and methods: A retrospective study of total 32 patients with tracheobronchial injury from 2001 to 2011. This study limited to patients with thoracic tracheal or bronchial injury, excluding those with cervical injuries. The study includes collected information about mechanism of injury, presentation, time until diagnosis and treatment, anatomical site of injury, type of treatment, diagnostic methods, duration of follow up and outcome. Results: Twenty-four patients were male (75%) and eight were females (25%). Patient’s ages ranged from 7 - 53 years. Majority of cases was referred because of blunt trauma in 15 cases (46.8%), 6 (18.75) motor vehicle accident, 5 (15.6%) fall from a height and 4 (12.5%) with trauma by heavy object, while 8 cases (25%) were referred due to penetrating injury and 2 cases (6.25%) due to iatrogenic injury. In initially diagnosed group, the predominant clinical signs that give a suspicion of tracheobronchial disruption were increased subcutaneous surgical emphysema, shortness of breath, hemoptysis. After the admission to emergency unit, all of them were examined radiologically by chest X-ray film. Longitudinal tear of right upper lobe bronchus was found in 8 cases (32%), complete cut of right upper lobe bronchus in 4 cases (16%), tear of right intermediate bronchus in 4 cases (16%), 3 cases with clear cut left upper lobe (12%), longitudinal tear of distal lateral tracheal wall extend to right upper lobe in 2 cases (8%), 2 cases (8%) showed complex disruption of distal trachea right main with carinal tear and 2 cases (8%) with longitudinal tear of membranous wall of the trachea. 17 patients from early diagnosed cases had concomitant comorbid extra thoracic injuries at the time of diagnosis in the form of abdominal trauma in 12 cases, skeletal fractures in 9 cases and head injury in 5 cases. Conclusion: In a patient with a complex bronchial rupture, primary repair of the bronchus can be possible with complete functional preservation of the lung tissue.展开更多
文摘Patients with severe mitral regurgitation (MR) should undergo surgery when they present symptoms or if asymptomatic when there is objective evidence of left ventricular dysfunction. In this work, we analyze the midterm results of leaflet augmentation in mitral valve repair of rheumatic valves with gluteraldehyde preserved autologous pericardium. Patients and Methods: In our department 48 patients were exposed to mitral valve repair by leaflet augmentation either anterior or posterior beside other technique and all patients supported by flexible annuloplasty ring and followed for five years clinically and by echocardiography. Results: Age of the patients ranging from 12 to 47 years, mean age 25.9 ± 8.9 and there were 12 males (25%) and 36 females (75%) with male to female ratio of 1:3. All patients presented with shortness of breath (100%);with 14 patients were in NYHA class III (29.17%) and 34 patients were in NYHA class IV (70.83%). During follow-up period 5 patients needed reoperation by valve replacement, causes of reoperation were restrictive valve motion in one patient, left atrial thrombus in 1 patient and sever mitral regurgitation in 3 patients. Freedom from reoperation was 87.5%. At 5 years, (92.9%) were in New York Heart Association functional class I, three patients (7.1%) were in class II. Echocardiography at follow-up showed satisfactory mitral valve function. Conclusion: leaflet augmentation is a simple and reproducible method of valve repair for rheumatic MR with good midterm result.
文摘Background: Tracheobronchial disruption as a result of blunt thoracic trauma is a rare entity and only clinically serious lesions come to our notice, which can be life-threatening and need prompt recognition and treatment. Objectives: To review the authors’ experience with tracheobronchial injuries to emphasize the need for prompt diagnosis and treatment to avoid lethal complications including severe hypoxic organ failure, sepsis, mediastinitis and bronchopleural fistula. Patients and methods: A retrospective study of total 32 patients with tracheobronchial injury from 2001 to 2011. This study limited to patients with thoracic tracheal or bronchial injury, excluding those with cervical injuries. The study includes collected information about mechanism of injury, presentation, time until diagnosis and treatment, anatomical site of injury, type of treatment, diagnostic methods, duration of follow up and outcome. Results: Twenty-four patients were male (75%) and eight were females (25%). Patient’s ages ranged from 7 - 53 years. Majority of cases was referred because of blunt trauma in 15 cases (46.8%), 6 (18.75) motor vehicle accident, 5 (15.6%) fall from a height and 4 (12.5%) with trauma by heavy object, while 8 cases (25%) were referred due to penetrating injury and 2 cases (6.25%) due to iatrogenic injury. In initially diagnosed group, the predominant clinical signs that give a suspicion of tracheobronchial disruption were increased subcutaneous surgical emphysema, shortness of breath, hemoptysis. After the admission to emergency unit, all of them were examined radiologically by chest X-ray film. Longitudinal tear of right upper lobe bronchus was found in 8 cases (32%), complete cut of right upper lobe bronchus in 4 cases (16%), tear of right intermediate bronchus in 4 cases (16%), 3 cases with clear cut left upper lobe (12%), longitudinal tear of distal lateral tracheal wall extend to right upper lobe in 2 cases (8%), 2 cases (8%) showed complex disruption of distal trachea right main with carinal tear and 2 cases (8%) with longitudinal tear of membranous wall of the trachea. 17 patients from early diagnosed cases had concomitant comorbid extra thoracic injuries at the time of diagnosis in the form of abdominal trauma in 12 cases, skeletal fractures in 9 cases and head injury in 5 cases. Conclusion: In a patient with a complex bronchial rupture, primary repair of the bronchus can be possible with complete functional preservation of the lung tissue.
