Long-term Echocardiography Characteristics and Their Clinical Significance of Patients after Mitral Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Xijun , ZHU Xiliang , TANG Hong , ZHOU Wenxia , ZHU Wei , BAI Wenjuan.

1. Department of Cardiovascular　Surgery， West China Hospital， Sichuan University， Chengdu 610041， P. R. China;;
2. Echocardiography Unit，Department of Cardiology， West China Hospital， Sichuan University， Chengdu 610041， P. R. China;

Corresponding author：

Keywords：

Mitral valve replacement; Echocardiography; Postoperative follow-up

DOI：

10. 7507/1007-4848. 20130047

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Objective To investigate long-term echocardiography characteristics and their clinical significance of patients after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 204 patients who underwent prosthetic MVR and finished echocardiography examination at least 5 years after surgery in West China Hospital of Sichuan University. There were 44 male patients and 160 female patients with their age of 23 to 73 （50.9±10.6）years. Postoperatively， all the patients were followed up for 5-15 （7.9±2.3）years and regularly received echocardiography examination at the outpatient department. Analysis variables included left atrium （LA） dimension， left ventricle （LV） dimension，right atrium （RA） dimension， right ventricle （RV） dimension， left ventricular ejection fraction （LVEF） and effective orificearea （EOA） of the mitral valve. Results Long-term echocardiography showed that LA and LV dimensions were signifi-cantly smaller than preoperative dimensions （P＜0.05）， while RA and RV dimensions were not statistically different from preoperative dimensions （P＞0.05）. Long-term LVEF was significantly higher than preoperative value （P＜0.05）. Long-term EOA was 1.1-4.8 （2.3±0.5）cm2， including EOA of 1.1-1.4 cm2 in 7 patients （3.4%，7/204），and 1.6-1.9 cm2in 42 patients （20.6%，42/204）. During long-term follow-up， 7 patients underwent their second heart surgery， including2 patients with prosthetic valve dysfunction， 1 patient with prosthetic perivalvular leak and severe hemolytic anemia，3 patients with severe tricuspid regurgitation which were not improved after medication treatment， and 1 patient with moderateaortic valve stenosis and regurgitation. Two patients had left atrial thrombosis during follow-up， including 1 patient who died of endocarditis 7 years after surgery， and another patient who was still receiving conservative therapy and further follow-up. Conclusion Concomitant tricuspid or aortic valve disease should be actively treated during MVR， and postoperative patients need better follow-up. Many patients after MVR need long-term cardiovascular medication treatment during follow-up in order to improve their heart function and long-term survival rate.

Citation： XIAO Xijun,ZHU Xiliang,TANG Hong,ZHOU Wenxia,ZHU Wei,BAI Wenjuan.. Long-term Echocardiography Characteristics and Their Clinical Significance of Patients after Mitral Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 148-151. doi: 10. 7507/1007-4848. 20130047 Copy

1.	张宝仁，徐志云，邢建洲，等. 单纯二尖瓣置换术3 416例疗效分析. 中华胸心血管外科杂志， 2005， 21 （4）：196-198.
2.	祁国奇，朱晓东，胡盛寿，等. 人工心脏瓣膜置换手术后的远期随访. 中华胸心血管外科杂志， 2003， 19 （4）：193-197.
3.	刘洋，徐志云，张宝仁，等. 259例应用国产C-L短柱侧倾碟瓣行二尖瓣置换术后15年随访. 中国胸心血管外科临床杂志， 2008， 15 （3）：161-164.
4.	Binder T， Baumgartner H， Maurer G. Diagnosis and management of prosthetic valve dysfunction. Curr Opin Cardiol， 1996， 11 （2）：131-138.
5.	Antunes MJ. Reoperations on cardiac valves. J Heart Valve Dis， 1992， 1 （1）： 15-28.
6.	Misawa Y， Saito T， Konishi H， et al. When and how does nonstructural mechanical prosthetic heart valve dysfunction occur ? Jpn J Thorac Cardiovasc Surg， 2003， 51 （8）：355-360.
7.	Vahanian A， Baumgartner H， Bax J， et al. Guidelines on the　management of valvular heart disease： The task force on the management of valvular heart disease of the European Society of Cardiology. Eur Heart J， 2007， 28 （2）： 230-268.
8.	Huysmans HA， David TE， Westady S， Chief Editor. Stentless　Bioprosthese. Oxford UK：Esis Medical Media Ltd， 1995. 727.
9.	唐红，肖锡俊，李嘉. 风湿性二尖瓣狭窄患者左心房流体力学观察. 中国胸心血管外科临床杂志， 2004， 11 （1）：42-44.
10.	Cohn LH， Chief Editor. Cardiac Surgery in the Adult. 3rd. New York： McGram-Hill， 2008. 1031-1068.
11.	Chan V， Ruel M， Mesana TG. Mitral valve replacement is a viable alternative to mitral valve repair for ischemic mitral　regurgitation： a case-matched study. Ann Thorac Surg， 2011， 92 （4）：1358-1365.
12.	Bonow RO， Carabello BA， Chatterjee K， et al.ACC/AHA 2006 guidelines for the management of patients with valvular heart disease：a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines （writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease） developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol， 2006， 48 （3）：e1-148.
13.	肖锡俊，袁宏声，唐红，等. 二尖瓣置换术后三尖瓣反流的逆转、残留或加重. 中国胸心血管外科临床杂志， 2006， 13 （5）：307-310.
14.	朱鹏，肖锡俊，唐红，等. 以三尖瓣瓣环径作为三尖瓣成形手术指征的初步临床观察. 中国胸心血管外科临床杂志， 2008， 15 （4）：245-248.
15.	Benedetto U， Melina G， Angeloni E， et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg， 2012， 143 （3）： 632-638.
16.	Ha JW， Choi SH， Chang BC， et al. Is prophylactic aortic valve　replacement in dicated during mitral valve surgery for mild to moderate aortic valve disease? Ann Thorac Surg， 2002， 94 （4）：1115-1119.
17.	荣昊，肖锡俊，魏东明，等. 无或伴轻度主动脉反流患者二尖瓣置换术后远期分析. 中国胸心血管外科临床杂志， 2010， 17 （2）：127-130.

1. 　张宝仁，徐志云，邢建洲，等. 单纯二尖瓣置换术3 416例疗效分析. 中华胸心血管外科杂志， 2005， 21 （4）：196-198.
2. 　祁国奇，朱晓东，胡盛寿，等. 人工心脏瓣膜置换手术后的远期随访. 中华胸心血管外科杂志， 2003， 19 （4）：193-197.
3. 　刘洋，徐志云，张宝仁，等. 259例应用国产C-L短柱侧倾碟瓣行二尖瓣置换术后15年随访. 中国胸心血管外科临床杂志， 2008， 15 （3）：161-164.
4. 　Binder T， Baumgartner H， Maurer G. Diagnosis and management of prosthetic valve dysfunction. Curr Opin Cardiol， 1996， 11 （2）：131-138.
5. 　Antunes MJ. Reoperations on cardiac valves. J Heart Valve Dis， 1992， 1 （1）： 15-28.
6. 　Misawa Y， Saito T， Konishi H， et al. When and how does nonstructural mechanical prosthetic heart valve dysfunction occur ? Jpn J Thorac Cardiovasc Surg， 2003， 51 （8）：355-360.
7. 　Vahanian A， Baumgartner H， Bax J， et al. Guidelines on the　management of valvular heart disease： The task force on the management of valvular heart disease of the European Society of Cardiology. Eur Heart J， 2007， 28 （2）： 230-268.
8. 　Huysmans HA， David TE， Westady S， Chief Editor. Stentless　Bioprosthese. Oxford UK：Esis Medical Media Ltd， 1995. 727.
9. 　唐红，肖锡俊，李嘉. 风湿性二尖瓣狭窄患者左心房流体力学观察. 中国胸心血管外科临床杂志， 2004， 11 （1）：42-44.
10. 　Cohn LH， Chief Editor. Cardiac Surgery in the Adult. 3rd. New York： McGram-Hill， 2008. 1031-1068.
11. 　Chan V， Ruel M， Mesana TG. Mitral valve replacement is a viable alternative to mitral valve repair for ischemic mitral　regurgitation： a case-matched study. Ann Thorac Surg， 2011， 92 （4）：1358-1365.
12. 　Bonow RO， Carabello BA， Chatterjee K， et al.ACC/AHA 2006 guidelines for the management of patients with valvular heart disease：a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines （writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease） developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol， 2006， 48 （3）：e1-148.
13. 　肖锡俊，袁宏声，唐红，等. 二尖瓣置换术后三尖瓣反流的逆转、残留或加重. 中国胸心血管外科临床杂志， 2006， 13 （5）：307-310.
14. 　朱鹏，肖锡俊，唐红，等. 以三尖瓣瓣环径作为三尖瓣成形手术指征的初步临床观察. 中国胸心血管外科临床杂志， 2008， 15 （4）：245-248.
15. 　Benedetto U， Melina G， Angeloni E， et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg， 2012， 143 （3）： 632-638.
16. 　Ha JW， Choi SH， Chang BC， et al. Is prophylactic aortic valve　replacement in dicated during mitral valve surgery for mild to moderate aortic valve disease? Ann Thorac Surg， 2002， 94 （4）：1115-1119.
17. 　荣昊，肖锡俊，魏东明，等. 无或伴轻度主动脉反流患者二尖瓣置换术后远期分析. 中国胸心血管外科临床杂志， 2010， 17 （2）：127-130.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term Echocardiography Characteristics and Their Clinical Significance of Patients after Mitral Valve Replacement

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