No definitive recommendation is available concerning optimal antithrombotic therapy in pregnant women with a mechanical heart valve. The purpose of the current study was to evaluate the clinical results of nadroparin treatment with respect to pregnancy outcome and maternal complications. From 1997 to 2005, 31 pregnancies were reviewed in 25 women. Nadroparin (7,500 U, twice daily) was used in 23 pregnancies between 6 and 12 weeks of gestation and close-to-term only, and coumarin derivatives were used with aspirin at other times. Eight pregnant women treated with coumarin derivatives throughout pregnancy were compared to evaluate the safety and efficacy of nadroparin. No maternal death or bleeding complication occurred in either of the two groups, and frequencies of maternal thromboembolism including valve thrombosis (8.7% vs. 12.5%, p>0.05) were similar. However, the frequencies of live born (91.3% vs. 50%, p=0.01) and healthy babies (90.4% vs. 25%, p<0.01) were significantly higher, and the fetal loss rate was significantly lower (8.7% vs. 50%, p=0.01) in the nadroparin-treated group. Regarding the efficacy and safety of antithrombotic treatment in pregnant women with prosthetic heart valves, nadroparin treatment during the first trimester is an acceptable regimen and produces better results than coumarin derivatives.
Treatment Outcome ; Thrombosis/etiology/*prevention & control ; Pregnancy Outcome ; Pregnancy Complications, Cardiovascular/*etiology/*prevention & control ; Pregnancy ; Nadroparin/*administration & dosage/*adverse effects ; Hydrocephalus/chemically induced ; Humans ; Heart Valve Prosthesis/*adverse effects ; Heart Valve Diseases/etiology/*prevention & control ; Female ; Coumarins/administration & dosage ; Adult

OBJECTIVETo analyze the early and long-term results after mitral-aortic valve replacement for rheumatic valvular disease and the determinant factors involved and subsequent therapies.

METHODS1 154 patients receiving combined mitral-aortic valve replacement for rheumatic valvular disease from May 1981 to May 2001 were reviewed. The mean age of the patients was 41.48 +/- 10.00 years. Concomitant valve plasty was performed for associated tricuspid organic or significant functional lesions. Lateral tilting disc or bileaflet valve prostheses were used for replacement. New York Heart Association functional status showed Class III or IV in 91.77% of the patients. Moderate to severe pulmonary hypertension occurred in 29.38% of the patients. The duration of follow-up varied from 8 months to 20 years.

RESULTSThe hospital mortality was decreased from 6.50% to 4.45%. The 5-, 10- and l5-year survival rates were 89.46% +/- 1.35%, 86.50% +/- l.91% and 67.86% +/- 6.16%, respectively. The 5-, 10- and l5-year thromboembolic event free rates were 97.80% +/- 0.74%, 88.31% +/- 2.20% and 94.08% +/- 2.29%, respectively. the 5-, 10- and l5-year anticoagulant related bleeding free rates were 94.80% +/- 1.09%, 89.32% +/- 2.10% and 83.12% +/- 3.57% respectively. Cardiac functional status returned to Class II in 98% patients and to Class III in 2% during follow-up.

CONCLUSIONSBoth left and right ventricular functions may be impaired as a result of rheumatic valvular disease. Tricuspid valve should be explored during surgery and any significant tricuspid annular enlargement and regurgitation showed be corrected in concomitance. Long-acting penicillin regimen is needed for 3 - 5 years for the prevention of rheumatic fever relapse. A low intensity anticoagulant regimen after valve replacement with prothrombin time targeting at 1.5 - 2.0 times is advisable in lessening anticoagulant related bleeding yet optimizing sufficient prevention against thromboembolic complications.

Adolescent ; Adult ; Aged ; Aortic Valve ; surgery ; Female ; Follow-Up Studies ; Heart Valve Diseases ; etiology ; surgery ; Heart Valve Prosthesis Implantation ; methods ; mortality ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Postoperative Complications ; prevention & control ; Recurrence ; Retrospective Studies ; Rheumatic Heart Disease ; complications ; prevention & control ; Survival Analysis ; Survival Rate ; Treatment Outcome ; Tricuspid Valve ; surgery ; Young Adult

OBJECTIVETo analyze the early and long-term results after mitral valve replacement for rheumatic valvular disease by using home-made tilting disc valve, and the determinant factors involved and subsequent therapies.

METHODSOne hundred and five patients, including 31 patients with rheumatic mitral stenosis, 92 patients with mixed mitral stenosis and regurgitation, and 2 patients with bacterial endocarditis, underwent prosthetic mitral valve replacement with home-made tilting disc valve from September 1978 to June 1982. Three patients had a history of mitral commissurotomy, and 5 patients had concomitant functional tricuspid regurgitation. All patients were operated on under cardiopulmonary bypass with implantation of 25 - 29 mm size home-made tilting disc valve prosthesis. The associated functional tricuspid lesions were treated at the same time with modified DeVega's valvuloplasty or Kays bicuspidate valvuloplasty.

RESULTSEleven patients died during the hospital stay with an early operative mortality of 8.8%. The major causes of the early death were low cardiac output syndrome (4 patients), respiratory failure (2), acute renal failure (2), extrinsic prosthesis dysfunction (1), ventricular arrhythmia (1), and left ventricular rupture (1). Ninety-eight survivors were followed up (total 1,162.2 years) for mean duration of 12.8 years. Eighty-nine patients (78%) survived over 10 years after operation, 58 (51%) over 15 years, and 55 (48%) over 20 years. There were 16 late deaths due to heart failure, anticoagulation related bleeding, thromboembolism and recurrence of rheumatic fever. The survival rates at 10 and 20 years were 82.3% and 51.1% respectively. Among the patients who survived over 20 years, 37 patients had the cardiac functional status returned to Class II, 13 Class III, and Class IV.

CONCLUSIONSSevere post-rheumatic valve deformity may occur in younger patients in China. Long-acting penicillin regimen given for 3 - 5 years for the prevention of rheumatic fever relapse is advocated. A low intensity anticoagulant regimen after mitral valve replacement is advisable in lowering the incidence of anticoagulant related bleeding, while optimizing sufficient protection against thromboembolic complication. Proper operative timing (e.g. when the patient is in sinus rhythm and in NYHA functional class II) is of great importance in achieving satisfied long-term results.

Adolescent ; Adult ; Anticoagulants ; administration & dosage ; adverse effects ; therapeutic use ; Female ; Follow-Up Studies ; Heart Valve Diseases ; etiology ; surgery ; Heart Valve Prosthesis Implantation ; instrumentation ; methods ; mortality ; Hemorrhage ; chemically induced ; prevention & control ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Rheumatic Heart Disease ; complications ; Secondary Prevention ; Survival Analysis ; Survival Rate ; Time Factors ; Treatment Outcome ; Young Adult

OBJECTIVE: To investigate the effects of different doses of fentanyl on the stress response in valve replacement surgery during cardiopulmonary bypass (CPB). METHODS: Thirty ASA II-III adult patients scheduled for cardial valve replacement were randomly divided into 3 groups: Group A (fentanyl 30 microg/kg), Group B (fentanyl 60 microg/kg), and Group C (fentanyl 100 microg/kg). Anesthesia was induced with medazalam 0.1 mg/kg, fentanyl 10 microg/kg and vecuronium 0.1 mg/kg; And were maintained with fentanyl and propofol infusion. Remained dose of fentanyl was used before the CPB. MAP, CVP, HR, P(ET)CO2, SpO2, nasal and rectal temperature were monitored continuously. Blood samples were taken before the operation (T1), before the CPB (T2), 30 min after the aortic declamping (T3), 2 h after the aortic declamping (T4), 24 h (T5) after the operation to determine the plasma levels of glucose, adrenocorticotropic hormone (ACTH), angiotensin II (AT II) and cortisol. RESULTS: Levels of glucose, ACTH, AT II and cortisol after the CPB (T3, T4 and T5) in 3 groups were significantly increased compared with that of T1 (P < 0.05 or P < 0.01). After CPB, at the same time point, among the 3 groups, the levels of the above index of Group A were the most highest, that of Group C were the most lowest. Glucose, ACTH, AT II and cortisol levels at T3 and T4 were significantly lower in Group B and C than those in Group A ( P < 0.05); But there was no significant difference between Group B and C. The duration of stay in the ICU and time of endotracheal extubation were significantly longer in patients of Group C than Group A and B (P < 0.05). CONCLUSION Fentanyl (30-100 microg/kg) can completely suppress the stress response induced by intubation and intense surgical stimulus before CPB. Different doses of fentanyl seemed to be effective in reducing CPB-induced stress response. But the effect was not dependent on dose. So 60 microg/kg fentanyl seemed to be an ideal dose.
Adrenocorticotropic Hormone ; blood ; Adult ; Anesthetics, Intravenous ; administration & dosage ; Angiotensin II ; blood ; Cardiopulmonary Bypass ; adverse effects ; Dose-Response Relationship, Drug ; Female ; Fentanyl ; administration & dosage ; Heart Valve Diseases ; blood ; psychology ; surgery ; Heart Valve Prosthesis Implantation ; adverse effects ; Humans ; Hydrocortisone ; blood ; Male ; Middle Aged ; Stress, Physiological ; etiology ; prevention & control

OBJECTIVE: To determine the effect of different doses of sufentanil on stress responses to tracheal intubation in patients undergoing heart valve replacement surgery. METHODS: Sixty patients undergoing heart valve replacement surgery were randomly divided into 4 groups (n=15). Before the tracheal intubation, patients received 10microg/kg fentanyl (Group A), 1microg/kg sufentanil (Group B ), 1.5micro/kg sufentanil (Group C), and 1.5microg/kg sufentanil (Group D), respectively, with midazolum and vecuronium intravenous injection. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded before the induction of anesthesia(T(0)), after the induction of anesthesia(T(1)), and at 1(T(2)), 3(T(3)), 5(T(4)), and 10 min after the tracheal intubation(T(5)). Rate-pressure product was derived from SBP and HR. Blood sugar was monitored at T(0), T(2) and T5. RESULTS: The SBP,DBP,MAP, HR and RPP at T(0) were not significantly different among the 4 groups (P>0.05). These parameters at T(1) were significantly lower than those at T(0) (P<0.01), but there was not significant difference among the 4 groups. The SBP, DBP, MAP in Group A increased significantly at T(2) and T(3) than those at T(1)(P<0.01 approximately 0.05), but were not significantly different than those at T(0)(P>0.05). The SBP,MAP in Group B,C,D at T(2) and T(3) were significantly lower than those in Group A (P<0.01 approximately 0.05 ). The SBP and MAP in Group D at T(4) were still lower than those in Group A (P<0.05). The HR at T(2) in Group A increased compared with that at T(1)(P<0.05),but was still lower than that at T(0). The HR at T(2) in Group B, C, and D was not significantly changed. The HR decreased significantly at T(2) in Group D compared with that in Group A(P<0.05), and the HR at T5 in Group A and D significantly decreased compared with that in Group B(P<0.05). The RPP at T(1) to T5 in Group B, C, and D significantly decreased compared with that at T(0)(P<0.01). The RPP at T(2) in Group A increased significantly compared with those in Group B, C, and D(P<0.01). The cases of using atropine during the induction and intubation in Group A,B,C, and D were 5(33.3%),0(0%),4(26.7%),5(33.3%),respectively, and the cases in Group B were significantly different compared with those in Group A and D(P<0.05). The change of blood sugar in Group A,B,C, and D was not significantly different(P>0.05). CONCLUSION Three doses of sufentanil may effectively control the stress responses to the tracheal intubation in patients undergoing heart valve replacement surgery, and the hemodynamics during the intubation at 1microg/kg is much more stable.
Adjuvants, Anesthesia ; administration & dosage ; Adolescent ; Adult ; Dose-Response Relationship, Drug ; Female ; Heart Valve Diseases ; surgery ; Heart Valve Prosthesis Implantation ; adverse effects ; methods ; Hemodynamics ; drug effects ; Humans ; Intubation, Intratracheal ; adverse effects ; methods ; Male ; Middle Aged ; Stress, Physiological ; etiology ; prevention & control ; Sufentanil ; administration & dosage ; Treatment Outcome

OBJECTIVETo observe the effect of pulmonary arterial perfusion with Shenqi Fuzheng Injection (SFI)on lung injury during cardiopulmonary bypass (CPB).

METHODSTwenty-two patients with cardiac valvular disease and pulmonary hypertension were randomly divided into the control and the SFI group equally. SFI mixed pure oxygenated blood to the SFI group, and oxygenated blood alone to the control group was perfused via pulmonary artery during CPB. Plasma malondialdehyde (MDA), pulmonary vascular resistance (PVR), ratio of leucocyte counts in venous and arterial blood, and time of mechanical ventilation applied were measured before and at the end of CPB, and 6th, 24th hours after CPB.

RESULTSAfter treatment, MDA content and PVR were significantly higher than those before CPB (P < 0.05), and reduced to normal level 24 h after CPB in both groups, but the peak levels were lower in the SFI group than those in the control group (P < 0.05). The leucocyte counts ratio in venous and arterial blood were significantly higher at the end of CPB and 6 h later than those before CPB in both groups (P < 0.05), but the increment were lower in the SFI group than those in the control group (P < 0.05). Furthermore, the applying mechanical ventilation time in the SFI group was 16.1 +/- 5.5 h, significantly shorter than that in the control group (29.1 +/- 6.9 h, P < 0.01).

CONCLUSIONPulmonary arterial perfusion with SFI could alleviate the CPB induced lung injury.

Adult ; Aged ; Cardiopulmonary Bypass ; adverse effects ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Female ; Heart Valve Diseases ; complications ; surgery ; Humans ; Hypertension, Pulmonary ; etiology ; surgery ; Infusions, Intra-Arterial ; Male ; Malondialdehyde ; blood ; Middle Aged ; Phytotherapy ; Pulmonary Artery ; Respiratory Distress Syndrome, Adult ; blood ; etiology ; prevention & control ; Treatment Outcome ; Vascular Resistance ; drug effects