Clinnical Therapy Of Patients With Severe Aortic Regurgitation And Giant Left Ventricle And The Study Of Functional Mitral Regurgitation In These Patients

BACKGROUND:Severe aortic regurgitation with giant left ventricle is a complicated heart disease, which has a higher incidence of perioperative complication and mortality than ordinary heart vavle operation.The early postoperative complications were ventricular arrhythmia and low cardiac output syndrome.With accumulation of clinical experience and improvement of treatment method(e.g.IABP),the perioperarive mortality of these patients was decreased greatly.Many follow-up trails showed enlardment of left ventricle resulting from Aortic lesions decreased and tend to be normal level after improvement of hemodynamics.Functional mitral regurgitation(FMR) defined as the failure of mitral valve to prevent systolic backward flow induced by cardiac disfunction or abnormal geometric structure in the absence of any significant structural or intrinsic valvular disease.FMR was very common in severe aortic stenosis or aortic regurgitation.Most of the international studies of FMR induced by aortic valve lesion were about aortic valve stenosis.The occurrence mechanism,operative indication and effect on the prognosis of FMR in these patients were well studied.However,only few data are available on FMR in patients with severe aortic regurgitation and giant left ventricle.We found FMR was very common in these patients.It was generally considered that left ventricular dilatation induced FMR in these patients.But The occurrence mechanism,operative indication and effect on the prognosis of FMR in these patients were still not clear.So,we performed the study of FMR in patients with severe aortic regurgitation and giant left ventricle to investigate its occurrence mechanism, and to get theoretical guidance for the clinical work.This study included two parts.Part One Clinical thrapy and follow-up results of patients with severe aortic regurgitation and giant Left ventricleObjective:To analyze the Clinical thrapy and follow-up results of patients with severe aortic regurgitation and giant Left ventricleMethods:According to the criterion(aortic regurgitation≥10ml and LVEDD≥7cm), 85 patients's data were collocted.All patients were performed AVR or Bentall operation. The complication and mortality were analyzed.With telephone and out-hospital follow-up, we collected the middle(6month -2year and long term(＞2year) survival condition and echocardiogram data after operation,and the prognostic and survival factors of these patients were analyzed.Results:1,The early postoperative complications were ventricular arrhythmia and low cardiac output syndrome.The mortality was 5.9%.2,The long term survival rate was 81.2%and main cause of late death was heart Failure.3 Follow-up data indicated that the left ventricular dilatation were reduced progressively and significantly after operation.The key period for the reversal is from 6 months to one year after operation..The post-operative left ventricular retraction were higher in patients with EF≥50%than in patients with EF＜50%before operation.Conclusion:1 The early postoperative complications were ventricular arrhythmia and low cardiac output syndrome.Prevention of arrhythmias and treatment of low cardiac output syndrome can decreased the perioperative mortality significantly.3 The left ventricular dilatation was reduced progressively and significantly after operation in these patients.Part Two Clinical study of functional mitral regurgitation of patients with giant Left ventricle and severe aortic regurgitationObjective:To analyze the incidence and post operation change of FMR of patients with severe aortic regurgitation(SAI) and giant left ventricle(GLV).Methods:Clinical materials and echocardiogram data after operation of 85 SAI+GLV patients were collected,and the FMR of these patients were analyzed.Results:1,The echocardiogram data indicated that the incidence of FMR in SAI+GLV patients was 81.18%.Pearson correlation analysis showed age and gender have no relationship with FMR.The degree of FMR was positively correlated with LVEDD, LVESD,ESV and EDV respectively,and negatively correlated with EF and FS.Adjusted by confound factors,multiple linear regression analyses showed variable influencing FMR were LVESD,ESV,LVEDD,EDV,EF and FS in turn. 2,The long-term improvement ratio of FMR is 82.81%,and had a strong relationship with left ventricular systolic function and degree of cardiac function and no relationship with the degree of FMR and MVP operation.Conclusion:Left ventricle enlargement and systolic dysfunction are the close correlation factors of FMR in SAI+GLV patients.The FMR improves in patients with good cardiac function and normal left ventricle systolic function index,while mitral insufficiency may improve after AVR and therefore its surgical treatment can be omitted.