Ishitoya H
Department of Cardiovascular Surgery, Tokyo Women's Medical University.
J Cardiol. 2000 Jul;36(1):37-44.
Surgical outcome for mitral regurgitation has significantly improved in recent years, so consideration of the optimal operative timing to achieve long-term quality of life for the patients has become more important. Preoperative indices that predict postoperative left ventricular function are very important for decision of the operative timing. To reassess the optimal operative timing for mitral regurgitation, long-term recovery of the postoperative left ventricular function was correlated with preoperative left ventricular end-systolic volume index(LVESVI).
One hundred eighty-two patients with mitral regurgitation underwent standard mitral valve replacement between January 1973 and June 1993. The patients were divided into 3 groups according to the preoperative LVESVI: Group I (LVESVI > or = 100 ml/m2) included 23 patients, Group II (60 < or = LVESVI < 100 ml/m2) 81 patients and Group III (LVESVI < 60 ml/m2) 78 patients. Two-dimensional echocardiography was performed to measure left ventricular diastolic dimension, systolic dimension, fractional shortening, end-systolic wall stress and mass index before operation(pre), and 1 month(early) and 3 years(late) after the operation.
Left ventricular diastolic dimension in each group decreased in the early period, but Group I returned to the abnormal range in the late period. Left ventricular systolic dimension in Groups I and II was at the upper limit of the normal range in the early period and returned to the abnormal range in the late period, but Group III remained within the normal range throughout the study. Fractional shortening in all groups decreased to the abnormal range in the early period, but only Group III returned to the normal range in the late period. End-systolic wall stress in Group I tended to increase, but Group II had no change, and Group III returned to the normal range during the early and late periods. Mass index in Groups I and II remained within the abnormal range, but Group III returned to the normal range in the late period.
Long-term recovery of the left ventricular function in Group I showed a continuous deterioration due to irreversible change of the left ventricular myocardium and Group II showed no significant change. In contrast, Group III demonstrated a significant improvement after standard mitral valve replacement. Patients with preoperative LVESVI of more than 100 ml/m2 have already lost the optimal timing for surgical treatment of mitral regurgitation.
近年来二尖瓣反流的手术效果有了显著改善，因此，考虑最佳手术时机以实现患者的长期生活质量变得更加重要。预测术后左心室功能的术前指标对于决定手术时机非常重要。为了重新评估二尖瓣反流的最佳手术时机，将术后左心室功能的长期恢复情况与术前左心室收缩末期容积指数（LVESVI）进行关联分析。
1973年1月至1993年6月期间，182例二尖瓣反流患者接受了标准二尖瓣置换术。根据术前LVESVI将患者分为3组：I组（LVESVI≥100 ml/m²）23例，II组（60≤LVESVI＜100 ml/m²）81例，III组（LVESVI＜60 ml/m²）78例。术前（pre）、术后1个月（早期）和术后3年（晚期）进行二维超声心动图检查，测量左心室舒张末期内径、收缩末期内径、缩短分数、收缩末期室壁应力和质量指数。
每组左心室舒张末期内径在早期均减小，但I组在晚期又回到异常范围。I组和II组左心室收缩末期内径在早期处于正常范围上限，晚期回到异常范围，但III组在整个研究期间均保持在正常范围内。所有组的缩短分数在早期均降至异常范围，但只有III组在晚期恢复到正常范围。I组收缩末期室壁应力有增加趋势，II组无变化，III组在早期和晚期均恢复到正常范围。I组和II组质量指数仍处于异常范围，但III组在晚期恢复到正常范围。
I组左心室功能的长期恢复显示因左心室心肌不可逆改变而持续恶化，II组无显著变化。相比之下，III组在标准二尖瓣置换术后有显著改善。术前LVESVI超过100 ml/m²的患者已经失去了二尖瓣反流手术治疗的最佳时机。
