Clinical Therapy And Study Results Of Patients With Severe Aortic Regurgitation And Giant Left Ventricle

Background and ObjectiveSevere aortic regurgitation with giant left ventricle is a complicated heart disease, which has a higher incidence of perioperative complication and mortality than ordinary heart valve 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 perioperative mortality of these patients was decreased greatly. Many follow-up trails showed enlardment of left ventricle resulting afrom Aortic lesions decreased and tend to be normal level after improvement of hemodynamics. To identify postoperative survival situation and left ventricular remodeling of severe aortic regurgitation with giant left ventricle, this study analyzes different left ventricular size postoperative complications and death cases, postoperative follow-up echocardiographic data, dynamic analysis, research as guidance on the timing of surgery and postoperative consolidation treatment provides the theory basis for future clinical work.Materials and Methods52consecutive patients (study group) underwent isolated aortic valve replacement or Bentall operation during July2004and June2013were analyzed retrospectively with serial echocardiograms. According to the left ventricular end-diastolic diameter size is divided into A, B two groups, the selected20cases of left ventricular end-diastolic diameter less than70mm of cases as control group, postoperative complications and death in patients and early postoperative within6months after operation, postoperative medium-term (after6months to2years) and late postoperative echocardiography (more than2years postoperative) data were analyzed, the postoperative survival situation and left ventricular remodeling of severe aortic regurgitation with giant left ventricle were got.Results1. There are15cases with early postoperative complications in study group, the incidence rate is28.8%, including ventricular arrhythmia in5cases, low cardiac output syndrome in6cases, the two accounted for73.3%of total complications.4cases died in early time, the death rate is7.69%,3cases died in AVR group,1case died Bentall group,2cases died of low cardiac syndrome,2cases died of ventricular arrhythmia, each accounted for50%.2.3cases died in postoperative midterm in study group, there are3patients lost to follow-up.2cases died of heart failure and1case died from acute cerebral hemorrhage. There are7cases died in postoperative forward,3cases were lost to follow-up,3cases died of heart failure,1case died of cardiac arrhythmia,3cases by non cardiac causes death, the rate of death from heart failure of long-term is71.4%in all causes of death from cardiac.3. The LVEDD and LVESD in patients who suffered from severe aortic regurgitation with giant left ventricle shrank progressively after operations.and compared with the preoperative, narrowed considerably at early stage, There were significant differences in statistics (t=5.18, P<0.01, t=7.41, P<0.01), the reshaping narrow in the middle of the postoperative process continues, slow, late to postoperative2years, still has not reached the level to normal size. Group research shows that:left ventricular remodeling in patients with LVEDD<80mm before operation is reversible; but it’s not reversibe in patients with LVEDD≥80mm.Conclusions1. The main postoperative complication of severe aortic regurgitation with giant left ventricle are low cardiac output syndrome and ventricular arrhythmias. The prevention and treatment of low cardiac output syndrome and ventricular arrhythmia is the key to improve the survival rate.2. The main cause of late death was heart failure, the risk indicators are as fellow: rheumatic etiology; preoperative heart function classification>Ⅲ level; preoperative left ventricular ejection fraction<50%.3. The shape of giant left ventricle can be restored after operation, preoperative LVEDD is the main influence factors of postoperative left ventricular retraction, LVEDD<80mm left ventricular remodeling is reversible, and LVEDD80mm or higher left ventricular remodeling is not reversible, therefore, aortic regurgitation with giant left ventricle should be received surgical treatment as soon as possible.