风湿性与非风湿性二尖瓣狭窄患者二尖瓣置换术后房颤及早期临床结局

Atrial Fibrillation and Early Clinical Outcomes After Mitral Valve Surgery in Patients with Rheumatic vs. Non-Rheumatic Mitral Stenosis.

作者信息

Mirhosseini S J, Ali-Hassan-Sayegh Sadegh, Hadadzadeh Mehdi, Naderi Nafiseh, Mostafavi Pour Manshadi S M Y

机构信息

Department of Cardiac Surgery, Yazd Cardiovascular Researches Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

出版信息

Heart Views. 2012 Oct;13(4):136-8. doi: 10.4103/1995-705X.105730.

DOI:10.4103/1995-705X.105730

PMID:23439740

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3573358/

Abstract

BACKGROUND

Atrial fibrillation (AF) is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. Mitral stenosis (MS) is a structural abnormality of the mitral valve apparatus that can be resulted from previous rheumatic fever or non-rheumatic fever such as congenital mitral stenosis, malignant carcinoid disease etc. This study was designed to test the hypothesis that type of mitral stenosis can affect the incidence, duration and frequency of AF post mitral valve replacement.

MATERIALS AND METHODS

We selected fifty patients with rheumatic mitral stenosis and 50 patients with non-rheumatic mitral stenosis who were candidates for mitral valve replacement (MVR) surgery. Pre-operative tests such as CRP, ESR, CBC, UA, ANA, APL (IgM, IgG), ANCA, RF were performed on participants' samples and the type of mitral stenosis, rheumatic or non-rheumatic, was determined clinically. Early post-operative complications such as infection, bleeding, vomiting, renal and respiratory dysfunction etc., were recorded. All patients underwent holter monitoring after being out of ICU to the time of discharge.

RESULTS

The mean age of patients was 48.56 ± 17.64 years. 57 cases (57%) were male, and 43 cases (43%) were female. Post-operative AF occurred in 14 cases (14%); 3 cases (6%) in non-rheumatic mitral stenosis group, and 11 cases (22%) in the rheumatic mitral stenosis group. There was a significant relationship between the incidence of AF and type of mitral stenosis (P = 0.02). Renal dysfunction after MVR was higher in rheumatic MS group than in non-rheumatic MS group (P = 0.026). There was no relationship between the type of mitral stenosis (rheumatic or non-rheumatic) and early mortality after mitral valve replacement (P = 0.8).

CONCLUSION

We concluded that the type of mitral stenosis affect post-operative outcomes, especially the incidence of atrial fibrillation and some complications after mitral valve replacement.

摘要

背景

心房颤动（AF）是心脏直视手术后最常见的心律失常，可导致术后早期发病和死亡。二尖瓣狭窄（MS）是二尖瓣装置的结构异常，可由既往风湿热或非风湿热引起，如先天性二尖瓣狭窄、恶性类癌病等。本研究旨在检验二尖瓣狭窄类型是否会影响二尖瓣置换术后房颤的发生率、持续时间和发作频率这一假设。

材料与方法

我们选择了50例风湿性二尖瓣狭窄患者和50例非风湿性二尖瓣狭窄患者，他们均为二尖瓣置换术（MVR）手术的候选者。对参与者的样本进行术前检查，如CRP、ESR、CBC、UA、ANA、APL（IgM、IgG）、ANCA、RF，并通过临床确定二尖瓣狭窄的类型，即风湿性或非风湿性。记录术后早期并发症，如感染、出血、呕吐、肾功能和呼吸功能障碍等。所有患者在转出重症监护病房后至出院期间均接受动态心电图监测。

结果

患者的平均年龄为48.56±17.64岁。57例（57%）为男性，43例（43%）为女性。术后房颤发生14例（14%）；非风湿性二尖瓣狭窄组3例（6%），风湿性二尖瓣狭窄组11例（22%）。房颤发生率与二尖瓣狭窄类型之间存在显著关系（P = 0.02）。风湿性MS组二尖瓣置换术后肾功能不全的发生率高于非风湿性MS组（P = 0.026）。二尖瓣狭窄类型（风湿性或非风湿性）与二尖瓣置换术后早期死亡率之间无关联（P = 0.8）。