A Clinical Study on the Surgical Treatment of the Rheumatic Cardiac Valve Disease.
- Author:
Jong Won KIM
1
;
Whang Kyoo CHUNG
;
Sung Kwang LEE
;
Byung Jun KIM
;
Young Woo SHIN
Author Information
1. Department of Thoracic and Cardiovascular Surgery, College of medicine, Pusan National University, Korea.
- Publication Type:Original Article
- Keywords:
heart valve disease;
herat valve replacement;
heart valve repair
- MeSH:
Aortic Valve;
Busan;
Cardiac Output, Low;
Diagnosis;
Echocardiography;
Embolism;
Female;
Fibrosis;
Follow-Up Studies;
Heart Valve Diseases;
Heart Valves*;
Hemorrhage;
Hospital Mortality;
Humans;
Male;
Mitral Valve;
Rheumatic Diseases;
Rheumatic Fever;
Thromboembolism;
Tricuspid Valve
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1998;31(4):346-352
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Rheumatic valvulitis produces at least three distinct pathologic changes, the degree varying widely among the patients: fusion of the valve leaflets at the commissures; fusion and shortening of chordae tendinae: and fibrosis of the leaflets with subsequent stiffening, contraction and calcification. The most extensive changes usually are seen in patients with recurrent attacks of rheumatic fever. We studied on outcome of the surgical treatments of rheumatic valvular diseases that have been experienced for 12 years since 1982 at Pusan National University Hospital. The diagnoses were made by rheumatic fever history, echocardiographic findings, gross operative findings and microscopic findings. Total 502 patients were performed surgery for valvular heart diseases and 440 patients of rheumatic origin have bene analysed. There were more female than male patients as 1.3:1, and the mean age was 37.8 years old. 96.3% of them affected to the mitral valve, 19.8% to aortic valve, 16.3% affected to the tricuspid valve. Most of them underwent valve replacement, and valve repair was done in 3.9% of patients. There were 36 hospital deaths (8.2%) mainly from low cardiac output syndrome, and 15 late deaths equally due to embolism and hemorrhage. Follow up was 90.1% completed (2890 patient-year). Linealized rates of late complication events are follows : thromboembolism 1.3% per patient year; anticoagulant related hemorrhage 0.8% per patient year. Overall actuarial survival including hospital mortality was 92.7+/-2.9% in 1 year, 88.0+/-4.5% in 5 year, 82.3+/-7.7% in 10 year. We conclude that the rheumatic disease is still the most frequent and the most important cause of heart valve disease. So more intensive study is needed in spite of the abrupt decreasing rate of rheumatic fever in U.S.A. and other industrial country.
