Objective To explore clinical application and significance of coronary angiography （CAG） prior to heart valve replacement for patients with rheumatic valvular heart disease （RVHD）. Methods We retrospectively analyzed clinical data of 313 RVHD patients who underwent heart valve replacement in the First Affiliated Hospital of Chongqing Medical University from January 2002 to June 2012. All the patients received screening CAG before surgery. According to CAG results，313 patients were divided into two groups. In the coronary artery lesion （CAL） group，there were 29 patients including 17 male and 12 female patients with their age of 60.0±5.2 years. In the non-coronary artery lesion （non-CAL）group，there were 284 patients including 98 male and 186 female patients with their age of 57.0±5.4 years. Surgicaloutcomes were compared between the two groups. Univariate analysis and multivariate logistic regression were performed to analyze risk factors of CAL for RVHD patients. Results CAG showed 29 patients with CAL，and the overall prevalence of CAL was 9.27%. In CAL group，11 patients underwent concomitant coronary artery bypass grafting with 2.2 grafts for each patient on the average. Postoperatively 1 patient （3.45%） died of low cardiac output syndrome （LCOS）. In non-CAL group，5 patients （1.76%） postoperatively died mainly because of LCOS，ventricular fibrillation，sudden cardiac arrest or respiratory failure. Cardiopulmonary bypass time and aortic cross-clamp time of CAL group were significantly longer than those of non-CAL group （P＜0.05）. There was no statistical difference in postoperative mortality，incidence of LCOS，acute renal failure，respiratory failure，reexploration for bleeding，intraoperative blood loss，mechanical ventilation time or hospital stay between the two groups（P＞0.05）. There was no significant correlation between the types of valvular lesions and CAL. Age≥ 55 years （OR=5.534，P=0.005），male gender （OR=2.335，P=0.038） and diabetes mellitus （OR=4.265，P=0.006） were independent risk factors of CAL for RVHD patients undergoing heart valve replacement. Conclusion For RVHD patients with independent risk factors of CAL （age≥55 years，male gender and diabetes mellitus），CAG must beseriously considered before heart valve replacement. RVHD patients with CAL can obtain similarly satisfactory surgicaloutcomes of heart valve replacement as RVHD patients without CAL by appropriate surgical strategy and strengthened perio-perative management.
ObjectiveTo observes the postoperative transformation of subjective and objective sleep quality and related influencing factors in patients with rheumatic valvular heart disease (RVHD) who were found with central sleep apnea (CSA) after cardiac valve replacement.MethodsA total of 262 patients undergoing cardiac valve replacement were screened for CSA by overnight polysomnography and 21 patients with CSA were enrolled and followed up successfully in the 3th, 6th and 12th month of postoperation from April 2010 to January 2013. The Pittsburgh Sleep Quality Index, Epworth Sleepiness, polysomnography and cardiac function were evaluated in preoperation and postoperation (in the 3th, 6th and 12th month).ResultsNew York Heart Association class ［preoperation and postoperation: (3.7±0.5), (2.3±0.6), (1.7±0.6), (1.6±0.7), F=81.124, P<0.05］ continuously decreased, left ventricular ejection fraction ［preoperation and postoperation: (58.5±6.8)%, (60.0±7.4)%, (60.9±5.6)%, (64.4±4.0)%, F=7.182, P<0.05］ steadily increased, six-minute walk distance ［preoperation and postoperation: (271.5±76.6), (422.1±71.9), (445.1±56.2), (454.5± 63.5) m, F=67.134, P<0.05］ constantly increased. During postoperative follow-up, sleep apnea-hypopnea index ［preoperation and postoperation: (26.2±13.4), (12.0±11.5), (8.6±7.5), (7.4±5.5)/h, F=20.548, P<0.05, central sleep apnea index ［preoperation and postoperation: (19.6±10.3), (0.5±1.5), (0.3±1.3), (0.2±0.7)/h, F=72.926, P<0.05］ and oxygen desaturation index ［preoperation and postoperation: (20.1±16.6), (10.8±9.5), (8.5±7.2), (6.1±5.1)/h, F=9.646, P<0.05］ sustained improved. Aroual index ［preoperation and postoperation: (23.1±12.1), (2.7±3.8), (3.5±4.8), (2.2±2.1)/h, F=58.370, P<0.05］ presented overall downward trend. Pittsburgh Sleep Quality Index scale ［preoperation and postoperation: (11.1±3.2), (8.2±3.3), (6.0±3.8), (4.4±2.5), F=27.670, P<0.05］ were constantly improved. Epworth Sleepiness scale ［preoperation and postoperation: (13.3±5.7), (6.9±4.5), (8.2±4.8), (6.1±3.7), F=15.994, P<0.05］ showed overall reduction.ConclusionThe sleep quality of patients with RVHD and CSA is improved after cardiac valve replacement, of which the trend is in keep with postoperative recovery of cardiac function.