3 Years Post-operative Outcome in Patients With Rheumatic Mitral Valve Stenosis and Small Left Ventricle
10.3969/j.issn.1000-3614.2016.07.016
- VernacularTitle:风湿性二尖瓣狭窄合并小左心室患者手术治疗的三年随访结果
- Author:
Jiyang WANG
;
Yi SONG
;
Xu YANG
;
Mei YANG
;
Xiaoyu ZHANG
;
Xiang LI
;
Runwei MA
- Publication Type:Journal Article
- Keywords:
Mitral valve stenosis;
Hypertension,pulmonary;
Small left ventricle;
Surgery
- From:
Chinese Circulation Journal
2016;31(7):687-691
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the peri-operative treatment and 3 years post-operative outcome in patients with rheumatic mitral valve stenosis and small left ventricle. Methods: A total of 152 patients with rheumatic mitral valve stenosis and severe pulmonary hypertension were studied. According to left ventricular end diastolic index (LVEDI) value, the patients were divided into 2 groups: Small left ventricle (Small) group, the patients with LVEDI value≤60 mm, n=67 and Non-small left ventricle (Non-small) group, the patients with LVEDI value>60 mm,n=85. Peri-operative condition and follow-up parameters were compared between 2 groups. Results: Compared with Non-small group, Small group had increased pre-operative CVP, SPAP and decreased LVEDV, LVEDVI and RVEF at admission, all P<0.05. All patients had liver damage at admission, the indexes (except alkaline phosphatase) were higher in Small group than Non-small group, and the function was recovered prior operation by proper treatment. The immediate post-operative SPAP in Small group and Non-small group were (67.3.1±23.4) mmHg and (61.3±26.9) mmHg, P>0.05. There were 52 severe pulmonary hypertension patients received iloprost inhalation, their SPAP was decreased than non-inhalation patients at incision closing; SPAP was lower in Small group inhalation patients than Non-small group inhalation patients, all P<0.05. Post-operative LVEDVI was lower and SPAP was higher in Small group than Non-small group. At 3 years post-operation, LVEDVI, RVEF increased, NYHA classification decreased and 6MWT prolonged in both groups; while LVEDVI was lower and 6MWT was shorter in Small group than Non-small group, P<0.05. The median survival time at (3.7±1.6) years post-operation was shorter in Small group than Non-small group,P<0.05, while the mortality was similar between 2 groups (2.6% vs 2.0%),P>0.05. Conclusion: The patients with mitral valve stenosis and small left ventricle had the worse pre-operative condition and higher risk in surgery; peri-operative treatment could improve their cardiac and liver function, but they still had the shorter post-operative median survival time.
