OBJECTIVETo explore the perioperative features of surgical treatment in valvular patients with small left ventricle, and investigate the postoperative early structural changes of left ventricle and its correlation with cardiac function.

METHODSA total of 51 patients with small left ventricle underwent mitral valve replacement from January 2003 to August 2008. There were 7 males and 44 females with mean age of (48 +/- 5) years old. The mean pathologic course was (18 +/- 9) years old. The concomitant procedures included aortic valve replacement in 6 cases, coronary artery bypass grafting in 1 case, tricuspid valvular plasty in 48 cases, left atrial thrombi scavenging in 36 cases, and left atrium folding in 42 cases.

RESULTSThe perioperative mortality was 3.9% (2/51). Fourteen patients (27.5%) suffered from severe low-output syndrome in the earlier period postoperatively. Among them, 5 patients needed secondary cardiopulmonary bypass (CPB) to assist circulation, with the result of 1 patient died of weaning off CPB unsuccessfully, 1 patient revived with intra-aortic balloon pump assisted for another 2 d after termination of CPB and another 1 patient died of multiple organ failure (MOF) 10 d later. Eleven cases complicated with MOF. Five patients complicated with ventricular arrhythmia. The echocardiographic examinations showed that the left ventricular dimensions didn't expand significantly postoperatively at 7 to 14 d postoperatively. Left ventricular end-diastolic diameter (LVEDD) was (36.5 +/- 3.2) mm preoperatively and (38.6 +/- 5.3) mm postoperatively (P > 0.05). Preoperative LVEDD index (LVEDDI) was (45.9 +/- 3.8) ml/m(2) and postoperative LVEDDI was (48.2 +/- 7.4) ml/m(2) (P > 0.05). The contract function of left ventricle was improved postoperatively but with no statistical significance. Ejection fraction was 48.6% +/- 6.7% preoperatively and 52.8% +/- 8.3% postoperatively. Left ventricular fraction shortness was 25.5% +/- 3.3% preoperatively and 27.1% +/- 1.3% postoperatively.

CONCLUSIONSFor the patients with small left ventricle usually, the postoperative emphases should be put on the management of low output syndrome. The decreased dimension of left ventricle doesn't expand in the early period after valvular operation.