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中国心脏瓣膜外科的发展与现状
Heart valve surgery in China dates back to 4 to 5 decades ago. In 1954, the first closed mitral commissurotomy was successfully performed in a patient with mitral stenosis. In 1960, with the advent of transventricular dilator and by the route of left ventricle, the efficacy of mitral commissurotomy was improved. The procedure was rapidly adopted by many centers in this country[1]. In 1958, the first open heart surgery using cardiopulmonary bypass was performed in China. This was an epoch-making event, which opened up a new era in the field of cardiac surgery in China. Thereafter, in cities like Beijing and Shanghai, direct repairs of mitral lesions under CPB were made with good results. In 1965, the development of the first totally home-made ball valve prosthesis and its successful application in mitral valve replacement was another landmark in the history of heart valve surgery in China. In 1976, aortic valve replacement with glutaraldehyde-preserved bovine pericardial valve prosthesis was carried out successfully. The next year, the first porcine aortic valve prosthesis was produced and introduced to clinical use, which greatly accelerated the progress of heart valve surgery in China. During the last 2 decades, heart valve surgery and its techniques have been widely applied throughout China.
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孤立性二尖瓣瓣上狭窄环1例
患儿,女,6岁,活动后心悸、气促3年,加重伴双下肢浮肿1月入院.既往有咯血史.查体:面部浮肿,口唇轻度发绀,端坐呼吸,双下肺可闻及湿罗音,心率82次/min,胸骨左缘3~4肋间可闻及4/6级收缩期杂音,P2亢进,肝右肋下3.5 cm,剑突下7 cm,移动性浊音阳性,心电图示窦性心律,右房,右室大.胸片示心胸比例为0.6,双肺淤血,间质性肺水肿,左房、右心增大.彩超示左房、右心明显增大,房间隔无中断,三尖瓣环扩大,关闭欠佳,二尖瓣开放、关闭好.左房内见膜状球形凸出图像,血流沿此腔边缘走行,压差加大,在主动脉短切6点方位有一11~12 mm管状回声,血流为高速、湍流、连续分流入左房,提示左房内囊样回声,性质待查,三尖瓣中-重度返流.术前诊断为先天性心脏病,三房心(左房排空障碍),三尖瓣返流,心功能Ⅲ级.
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三房心与二尖瓣瓣上狭窄的诊断和治疗(附3例报告)
我院自1979~1996年底共收治先心病1 317例,其中三房心2例,二尖瓣瓣上狭窄(supravalvular mitral stenosis, SVMS)1例,均经手术治愈,现报告于下.
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二尖瓣狭窄左房耳部瘤样突出1例报告
患者女,39岁.活动后心悸、气短13年,加重4月主诉入院,曾被诊断为风湿性心脏病.查体:心尖搏动强,在左锁骨中线5、6肋间,可触及收缩期细震颤,心率98次/min,律不齐,第一心音强弱不等,二尖瓣听诊区可闻及4/6级收缩期吹风样杂音,主动脉瓣听诊区可闻及收缩期3/6级吹风样杂音.