Topal Aşkin Ender, Eren Mehmet Nesimi, Celik Yusuf
Cardiovascular Surgery Department, Medicine Faculty, Dicle University, Diyarbakir, Turkey.
J Card Surg. 2010 Jul;25(4):367-72. doi: 10.1111/j.1540-8191.2010.01062.x. Epub 2010 May 30.
The objective of this study was to evaluate the recovery of the left ventricle (LV) function, and to analyze postoperative size reduction of LV and left atrium (LA), after mitral valve replacement (MVR) in patients with chronic rheumatic mitral disease.
Thirty consecutive elective patients with MVR for mixed mitral disease of rheumatic origin formed the study group. Of these, 21 (70%) were women and the mean age was 37 years. Transthoracic echocardiography was performed prior to surgery, at three-month follow-up, and at three-year follow-up except for the latest nine patients.
The mean duration of follow-up was 3.6 +/- 1.8 years. MVR surgery improved the functional class (mean New York Heart Association [NYHA] class) at three-year follow-up (p = 0.008). LV end-diastolic diameter and LA sizes decreased after MVR. Total chordal preservation causes better outcome, regarding to LV ejection fraction (LVEF) and NYHA functional class of patients. Preoperative high NYHA class, low LVEF, and high LV end-systolic diameter (LVESd) resulted with postoperative LV dysfunction (p were < 0.001, < 0.001, and 0.006, respectively).
In patients with mixed mitral valve disease, MVR enhanced LV and LA remodeling resulting in better NYHA function. Preoperative NYHA, LVEF, and LVESd were significant predictors of postoperative LV function.
本研究的目的是评估慢性风湿性二尖瓣疾病患者二尖瓣置换术（MVR）后左心室（LV）功能的恢复情况，并分析术后左心室和左心房（LA）的尺寸缩小情况。
连续30例因风湿性混合性二尖瓣疾病接受MVR的择期患者组成研究组。其中，21例（70%）为女性，平均年龄37岁。除最后9例患者外，在手术前、术后3个月随访以及术后3年随访时均进行经胸超声心动图检查。
平均随访时间为3.6±1.8年。MVR手术在术后3年随访时改善了心功能分级（平均纽约心脏协会[NYHA]分级）（p = 0.008）。MVR术后左心室舒张末期直径和左心房尺寸减小。就患者的左心室射血分数（LVEF）和NYHA心功能分级而言，保留全部腱索可带来更好的结果。术前NYHA分级高、LVEF低和左心室收缩末期直径（LVESd）高与术后左心室功能障碍相关（p分别<0.001、<0.001和0.006）。
在混合性二尖瓣疾病患者中，MVR促进了左心室和左心房重塑，从而改善了NYHA功能。术前NYHA分级、LVEF和LVESd是术后左心室功能的重要预测指标。
