ObjectiveTo investigate effect of cardiac function and tricuspid regurgitation (TR) degree of concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent mitral valve replacement (MVR), and provide an objective basis for clinical decision about concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR. MethodsA total of 36 patients who underwent MVR from April to October 2013 in Department of Cardiovascular Surgery, West China Hospital, Sichuan University were enrolled in this study. Preoperative echocardiography showed mild TR and tricuspid valve annular end-diastolic dimension (TVAEDD)/body surface area (BSA)>21 mm/m2. All the 36 patients were randomly divided into a tricuspid annuloplasty group (TAPG group, n=18, including 7 males and 11 females) and a no tricuspid annuloplasty group (NTAPG group, n=18, including 6 males and 12 females). One week and 6 months postoperative echocardiography were recorded. ResultsThere were no statistical differences in age, gender, heart rate, body surface area, preoperative cardiac function (NYHA), left atrium dimension (LAD), left ventricular dimension (LVD), maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension (RVD2), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) between the two groups (P>0.05). Six-months postoperative left atrial-ventricular diameter significantly reduced than that before surgery in the two groups (P<0.05). In the TAPG group, six-months postoperative right ventricle dimension (RVD1), right ventricular wall thickness (RVWT), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) significantly decreased, while percent shorting of tricuspid valve annulus (PSTVA) did not change significantly (P>0.05), TR degree improved significantly (P<0.05), right ventricular fractional area change (RVFAC) and right ventricular ejection fraction (RVEF) significantly increased (P<0.05). In the NTAPG group, compared with preoperative data, six-months postoperative RVD1, RVWT significantly increased, TVAEDD, TVAESD, PSTVA did not change significantly (P>0.05), RVEF reduced significantly (P<0.05), RVFAC increased significantly but less than that in the TAPG group at the same period, constituent ratio of TR changed significantly (P<0.05), but postoperative moderate or more TR were recorded in 6 patients. ConclusionConcomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent mitral valve replacement (MVR) can help to decrease RVD1, RVWT, TVAEDD and TVAESD, improve the constituent ratio of TR, and increase RVFAC and RVEF.
ObjectiveTo investigate long-term echocardiographic outcomes of patients after mitral and aortic valve replacement and their clinical significance. MethodsA total of 204 patients who underwent mitral and aortic valve replacement from January 1999 to June 2008 in West China Hospital of Sichuan University, and had been followed up with echocardiography for longer than 5 years were enrolled in this study. There were 60 male and 144 female patients with their age ranging from 15 to 74 (48.42±11.00)years. Postoperative follow-up time was 5 to 13 (6.34±2.05)years. Preoperative and follow-up echocardiographic results were compared. ResultsCompared with preoperative results, postoperative left atrial diameter (LA)and left ventricular diameter (LV)significantly decreased (P < 0.05), while right ventricular diameter (RV), left ventricular ejection fraction (LVEF)and left ventricular fractional shortening (LVFS)significantly increased (P < 0.05). Right atrial diameter (RA)did not change significantly (P > 0.05). In the patients mainly with mitral stenosis preoperatively, postoperative LA, LV, left atrial area (LAA), left atrial volume (LAV), mitral mean pressure gradient (MPGmv), velocity time integral (VTImv)and pressure half time (PHTmv)significantly decreased (P < 0.05), while mitral effective orifice area (EOAmv)and effective orifice area index (EOAImv)increased significantly (P < 0.05), but peak E velocity (Emv)did not change significantly (P > 0.05). In the patients mainly with mitral regurgitation preoperatively, postoperative LA and LV decreased significantly (P < 0.05), while LAA, LAV, MPGmv, VTImv, PHTmv, EOAmv and EOAImv did not change significantly (P > 0.05). In the patients mainly with aortic stenosis preoperatively, postoperative LV, interventricular septal thickness (IVS), left ventricular mass (LVM), left ventricular mass index (LVMI), aortic peak forward flow velocity(Vav)and mean pressure gradient (MPGav)significantly decreased (P < 0.05), while aortic effective orifice area (EOAav)and effective orifice area index (EOAIav)significantly increased (P < 0.05), but left ventricular posterior wall thickness (LVPW)did not change significantly (P > 0.05). In the patients mainly with aortic regurgitation preoperatively, postoperative LV, LVM, LVMI, EOAav and EOAIav decreased significantly (P < 0.05), while Vav and MPGav increased significantly (P < 0.05), but IVS and LVPW did not change significantly (P > 0.05). In mitral position, compared with patients with 25 mm prosthesis, Emv, MPGmv and VTImv of patients with 27 mm prosthesis were significantly smaller (P < 0.05), but there was no statistical difference in PHTmv, EOAmv or EOAImv between the 2 groups (P > 0.05). In aortic position, compared with patients with 21mm prosthesis, Vav, MPGav and VTIav of patients with 23 mm prosthesis were significantly smaller (P < 0.05), while EOAav and EOAIav were significantly larger (P < 0.05). In mitral position, 38 patients (21.3%)had moderate prothesis-patient mismatch (PPM)and 4 patients (2.3%)had severe PPM. In aortic position, 50 patients (24.5%)had moderate PPM and 43 patients (21.1%)had severe PPM. Consti-tuent ratio of long-term tricuspid regurgitation (TR)degree of patients after tricuspid valvuloplasty (TVP)significantly improved (P < 0.05), but constituent ratio of long-term TR degree of patients without TVP significantly deteriorated (P < 0.05). ConclusionsLeft ventricular function and hemodynamic outcomes in the long term are significantly better than preoperative results after double valve replacement, but they are still far from normal. PPM in aortic position is more severe than that in mitral position. Since residual or aggravated TR is very common in the long term, concomitant TVP should be considered more positively for patients undergoing surgery for left-sided valvular disease.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
Objective To evaluate the quality of anticoagulant therapy in patients with mechanical prosthetic valve replacement during early period through time in therapeutic range(TTR) and fraction of time in therapeutic range(FTTR), and to provide an objective evidence for further improving quality of anticoagulant therapy. Methods All the patients were followed and registered in hospital and at outpatient clinic from July 2012 through April 2014, with a maximum of 6 months after surgery. Targeted international normalized rate (INR) was 1.60 to 2.20, acceptable INR was 1.50 to 2.30. And warfarin weekly dosage adjustment was used as the strategy of anticoagulation management. Adjusting the warfarin dosage when INR was beyond acceptable INR. Events of bleeding, thrombogenesis and thromboembolism, TTR and FTTR of these patients during the follow-up were collected to evaluate quality of anticoagulant therapy in these patients. Results A total 477 patients and 2 755 reports of INR values were included for data analysis. The follow-up time was 78 918 days. Values of INR varied from 0.92 to 7.72(1.83±0.64). Required weekly doses of warfarin in target INR and acceptable INR were 5.00–35.00(18.15±3.99) mg/week and 5.00–39.38(18.29±4.08) mg/week. TTR of target INR and acceptable INR was 36.85%(27 079.5 d/78 918.0 d) and 49.84% (39 331.5 d/78 918.0 d), respectively. FTTR of target INR and acceptable INR was 37.31% (1 028 times/2 755 times), 50.01% (1 378 times/2 755 times), respectively. TTR of target INR and acceptable INR was 46.04%(3 902.5 d/8 475.5 d), 59.49%(5 042 d/8 475.5 d) when the patients’ follow-up was up to six months and FTTR of target INR and acceptable INR value of these patients was 46.81%(206 times/440 times), 60.45%(266 times/440 times). During the follow-up, there were 3 thromboembolism events, 1 transient physical abnormal activity, and 1 thrombogenesis in the left atrium, and there was no bleeding and death events. Conclusion The strategy of anticoagulation management used in our study is reasonable. In order to further improve the patients’ quality of anticoagulant therapy, it is necessary to start anticoagulation after operation as soon as possible, to strengthen the education of patients with anticoagulant knowledge and to increase INR test frequency properly.
Objective To evaluate the right ventricular function of the patients 2 years after surgery by ultrasonic cardiography (UCG) who underwent mitral valve replacement (MVR) concomitant tricuspid annuloplasty (TAP). Method We finally identified 36 patients required MVR with tricuspid valve annular dilation concomitant merely mild tricuspid regurgitaion (TR) based on preoperative UCG in our hospital between April and November 2012 year. All patients were randomly divided into two groups by digital table including a tricuspid annuloplasty group (a TAP group, n=18, 7 males and 11 females at age of 45.67±12.49 years) and a no-tricuspid annuloplasty group (a NTAP group, n=18, 6 males and 12 females at age of 45.44±10.48 years). General clinical data and extracorporeal circulation data were recorded. UCG evaluation was practiced preoperation, alone with 1 week, 6 months, and 2 years after surgery. Results Two years postoperative maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension-1(RVD1) , right ventricular fractional area change (RVFAC), 3D RV end-systolic volume (3DRVESV), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) of patients were all smaller in the TAP group than those in the NTAP group. Yet right ventricular ejection fraction (RVEF), percent shorting of tricuspid valve annulus (PSTVA) were greater in the TAP group than those in the NTAP group, although there was no statistical difference between the two groups in two years postoperative 3D RV end-diastolic volume (3DRVEDV). The patients in the TAP group had a superior trend than that of the NTAP group. Moreover, the patients' TR constituent ratio in the TAP group was much better than that of the NTAP group in 2 year after operation. Conclusions Concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR is favorable for the recovery of their 2 years postoperative function of tricuspid valve and right ventricle. It is benefit to reduce patient's long term postoperative TR residues and exacerbation.