| Background and purpose: One of the most common complications of rheumatic mitral valve stenosis is pulmonary arterial hypertension(PAH).The incidence can be as high as 56% [1].PAH is an important factor leading to related complications,and PAH is also an operation for patients undergoing mitral valve surgery.An important predictor of mortality [2].The traditional view [3] believes that: pulmonary arterial hypertension is a related risk factor for poor prognosis of patients with mitral valve replacement(mitral valve replacement,MVR),and the degree of pulmonary arterial hypertension is positively correlated with the risk of mitral valve replacement.With the advancement of medical technology,the mortality rate caused by MVR has dropped from the highest 31% to the current highest 11.6% [4],but some scholars still believe that severe PAH is an absolute contraindication to MVR,and mitral valve disease at this stage There is no consensus on MVR for patients with different degrees of PAH,and PAH has not yet reached a unified prognosis for patients after MVR [5],especially for patients with severe pulmonary arterial hypertension,there is some controversy about the short-term efficacy of mitral valve replacement.This study aims to explore the impact of different degrees of pulmonary arterial hypertension on the short-term clinical effects of rheumatic mitral valve disease after valve replacement,and to provide a theoretical basis for the treatment and prognosis of patients with mitral valve disease and different degrees of PAH.Methods: A retrospective analysis of 80 patients with mitral valve stenosis(or with insufficiency)and different degrees of PAH who underwent mitral valve replacement and were admitted to the Department of Cardiovascular Surgery of the Second Affiliated Hospital of Zhengzhou University from June 2013 to June 2019.According to clinical data,the pulmonary artery pressure is divided into three groups: mild,moderate and severe according to the results of Doppler echocardiography,mild group(30 mm Hg~50 mm Hg),moderate group(50mm Hg~70 mm Hg)and severe(PASP≥ 70 mm Hg).The measurement data is " X±S ",the statistical method is the comparison between multiple groups using one-way analysis of variance,the pairwise comparison between groups is using the q test;the counting data is expressed in the number of cases(n),percentage(%),and statistical methods Use X2 test.X2 test was used for PAH recovery rate before operation,perioperative period and 6-month follow-up after operation.The test level is P<0.05 as the difference is statistically significant.Mainly observe and compare the general information of the three groups of patients,operation-related indicators,perioperative complications and 6-month follow-up results.Results: There was no significant difference in the basic preoperative conditions of the three groups of patients,such as age,gender,medical history,heart rate,left ventricular ejection fraction,and left ventricular diameter(P>0.05);patients with severe pulmonary arterial hypertension were compared with mild and moderate groups Compared with patients,the mitral valve orifice area was significantly reduced,the degree of cardiac function worsened,the tricuspid regurgitation increased,the left atrial diameter and the right ventricular diameter increased significantly,the pulmonary artery width increased,the blood flow velocity increased,and the pulmonary artery pressure increased(P <0.05).There were no significant differences in the three groups of intraoperative valve replacement type,tricuspid valvuloplasty,preservation of mitral subvalvular structure,left atrial folding and thrombectomy,radiofrequency ablation,aortic occlusion time,and cardiopulmonary bypass occlusion time(P>0.05);The severe group’s mechanical ventilation time,SICU residence time and hospital stay were longer than those of the mild group and the severe group,with significant statistical differences(P<0.05);postoperative complications,low cardiac output syndrome,incision There were no significant differences among the three groups of infection,secondary surgery to stop bleeding,secondary thoracotomy,and renal insufficiency(P>0.05);the severe pulmonary artery hypertension group had postoperative complications in the mild and moderate groups.The incidence of local infection,pericardial effusion,and arrhythmia increased significantly,with significant statistical differences(P<0.05);the LVEF at 10 days after surgery and 6 months after surgery in the 3 groups was not statistically compared with that before surgery Academic significance(P>0.05).In the three groups of patients at the 10-day and 6-month follow-up,the right ventricular diameter,pulmonary artery width,blood flow velocity and PASP were significantly lower than those before the operation(P<0.05);The right ventricular diameter,blood flow velocity,and PASP of the moderate and severe group were significantly increased compared with the mild and moderate groups(P<0.05).The 6-month follow-up of the 3 groups of patients was compared with the operation of the left atrial diameter.Significantly reduced compared to the previous(P<0.05).Conclusions: 1.In patients with severe pulmonary arterial hypertension,the postoperative mechanical ventilation time,SICU retention time,and hospitalization time were significantly prolonged in the mild and moderate groups.2.The incidence of postoperative pulmonary infection,pericardial effusion,and arrhythmia is higher in the severe pulmonary arterial hypertension group,but postoperative PASP,left atrial diameter,pulmonary artery width,right ventricular diameter and mitral valve orifice blood flow velocity can be significantly reduced.3.The recovery rate of PAH in patients with severe pulmonary arterial hypertension at six months after surgery was lower than that in the mild and moderate group.A few in the severe group can return to normal,most in the moderate group can return to normal,and the mild group can completely return to normal(44.44%)vs82.61%vs100%).In summary,it is recommended that patients with rheumatic mitral valve disease with varying degrees of pulmonary arterial hypertension should undergo surgery as soon as possible. |
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