Hassanin Noha, Sharaf Yasser, Ammar Waleed, Sayed Amr Y H
Cardiovascular Department, Cairo University, Cairo, 002020, EgyptEgypt.
J Saudi Heart Assoc. 2017 Jul;29(3):160-168. doi: 10.1016/j.jsha.2016.10.008. Epub 2016 Dec 21.
Several reports described the incidence of postoperative paravalvular leakage (PVL) early after valve replacement surgery, however, there is a paucity of data regarding the outcomes and complications correlated to the severity of PVL. The aim of the current study was to evaluate the incidence, causes, and short term outcome of early postoperative PVL.
Data were collected from patients presenting to the cardiovascular department at Cairo University Hospital for aortic and/or mitral valve replacement surgery from May 2014 to May 2015. Transthoracic echocardiography (TTE) was done for all patients early postoperative. Transesophageal echocardiography (TEE) was done if diagnosis was not confirmed by TTE. All patients with detected PVL were subjected to TTE and TEE after a 3 month follow-up period.
Two hundred patients were enrolled in the study. Seventy five percent of patients were known to have rheumatic heart disease, while 16.5% had infective endocarditis. The mitral valve was replaced in 40% of patients, the aortic valve was replaced in 36%, and other patients had both valves replaced. Early postoperative period PVL was detected in 25 patients. The most common underlying etiologies were rheumatic heart disease and infective endocarditis. PVL was common in patients with both valves replaced compared with either mitral or aortic valve replacement. Infective endocarditis as underlying valve disease was significantly high in patients with PVL compared with those without ( < 0.001).
The incidence of PVL was high in patients with both valves replaced compared with either mitral or aortic valve replacement. Moreover, every patient with PVL should be properly investigated for infective endocarditis. Surgical intervention, although associated with high morbidity and mortality, reduces PVL recurrence.
多项报告描述了瓣膜置换术后早期瓣周漏（PVL）的发生率，然而，关于与PVL严重程度相关的结局和并发症的数据却很匮乏。本研究的目的是评估术后早期PVL的发生率、病因及短期结局。
收集2014年5月至2015年5月在开罗大学医院心血管科接受主动脉和/或二尖瓣置换手术患者的数据。所有患者术后早期均行经胸超声心动图（TTE）检查。若TTE未确诊，则行食管超声心动图（TEE）检查。所有检测到PVL的患者在随访3个月后均接受TTE和TEE检查。
200例患者纳入本研究。75%的患者已知患有风湿性心脏病，16.5%的患者患有感染性心内膜炎。40%的患者置换二尖瓣，36%的患者置换主动脉瓣，其他患者同时置换两个瓣膜。25例患者术后早期检测到PVL。最常见的潜在病因是风湿性心脏病和感染性心内膜炎。与单纯置换二尖瓣或主动脉瓣相比，同时置换两个瓣膜的患者中PVL更为常见。与无PVL的患者相比，有PVL的患者中潜在瓣膜病为感染性心内膜炎的比例显著更高（<0.001）。
与单纯置换二尖瓣或主动脉瓣相比，同时置换两个瓣膜的患者中PVL的发生率更高。此外，每例PVL患者均应接受感染性心内膜炎的适当检查。手术干预虽然与高发病率和死亡率相关，但可降低PVL复发率。
