Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil.
Department of Echocardiography, Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil.
Braz J Cardiovasc Surg. 2021 Aug 6;36(4):468-475. doi: 10.21470/1678-9741-2020-0641.
Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon. We intend to determine the pattern of left ventricular remodeling, shortly after open mitral valve replacement for rheumatic mitral stenosis, with in-hospital postoperative outcomes and the determinants of postoperative worsening of left ventricular ejection fraction.
From January 2008 to January 2015, 107 adult patients with rheumatic mitral stenosis were submitted to open mitral valve replacement. Their mean age was 45±11 years and 93 (86.9%) were women. Left ventricular morphology and function were studied longitudinally with echocardiography. The end point was postoperative worsening of left ventricular ejection fraction, defined by a decrease of 10% compared to preoperative basal assessment. Determinants of worsening left ventricular ejection fraction were determined by multivariable logistic regression analysis.
The end point occurred in 18 patients (16.8%). We tested clinical and echocardiographic parameters to verify independent variables related to the decrease in postoperative ejection fraction. Lower body weight (P=0.005; odds ratio [OR]=0.89) and smaller preoperative mitral valve area (P=0.02; OR=0.02) were independent predictors of left ventricular dysfunction. These patients presented higher mortality and morbidity rates.
Left ventricular remodeling patterns differed among patients with predominant rheumatic mitral stenosis undergoing open mitral valve replacement. Lower preoperative body weight and mitral valve area were independent determinants of deteriorating ejection fraction with increased end-systolic volumes, indicating that this specific problem may occur in anthropometric smaller patients with more extensive rheumatic disease.
风湿性二尖瓣狭窄手术后左心室功能障碍并不常见。我们旨在确定风湿性二尖瓣狭窄行二尖瓣置换术后短期内左心室重构的模式，以及住院期间术后的结局和左心室射血分数恶化的决定因素。
2008 年 1 月至 2015 年 1 月，107 例成人风湿性二尖瓣狭窄患者接受了二尖瓣置换术。患者的平均年龄为 45±11 岁，93 例（86.9%）为女性。通过超声心动图对左心室形态和功能进行了纵向研究。术后左心室射血分数恶化的终点定义为与术前基础评估相比下降 10%。采用多变量逻辑回归分析确定左心室射血分数恶化的决定因素。
18 例患者（16.8%）发生了终点事件。我们测试了临床和超声心动图参数，以验证与术后射血分数降低相关的独立变量。体重较轻（P=0.005；比值比[OR]=0.89）和术前二尖瓣瓣口面积较小（P=0.02；OR=0.02）是左心室功能障碍的独立预测因素。这些患者的死亡率和发病率较高。
在接受二尖瓣置换术的以风湿性二尖瓣狭窄为主的患者中，左心室重构模式存在差异。较低的术前体重和二尖瓣瓣口面积是射血分数恶化的独立决定因素，伴有收缩末期容积增加，表明这种特定的问题可能发生在风湿性疾病更广泛的体型较小的患者中。
