Clinical Outcome Of Surgical Treatment For Patients With Small Left Ventricle Associated With Severe Mitral Stenosis

Objective:To evaluate the clinical outcome of comprehensive treatment in preoperative period for patients with severe mitral stenosis associated with small left ventricle.Methods:(1)We analyzed the clinical data of76 patients with severe rheumatic mitral stenosis, all patients were divided into the small left ventricle group (33 cases) and the non-small leftventricle group (43 cases).(2) Clinical evaluations were performed before surgery, at preoperative period and 1 year follow-up, including:the CVP at preoperative period, the use of vasoactive agents, dosage of blood coagulation factor, the RVEF, LVEDVI, SPAP, liver function, the distance of 6MWT, NYHA class, the score of SF-36 of when admitted and after operations, early postoperative complications, postoperative mechanical ventilation time and care unit check-in time and postoperative hospital stay were used as a measurement of recovery. The Warfarin dose, rehospitalization rate, thromboembolism and mortality after operations were collected.(3)The perioperative and follow-up clinical parameters of 2 groups were compared.Results:(1). The CVP of the small left ventricle group was higher than the non-small left ventricle group when patients entering, in the same time, the RVEF was significantly worse than the non-small left ventricle group(P<0.05).The liver function was also worse than the non-small left ventricle group.(2). The liver function before surgery of the small left ventricle group was better compared with admission, however, more patients used cryoprecipitate after surgery.(3). The CVP and RVEF of the postoperative in both groups were better than entering, there were no significant difference between the two groups. The surgery can generate significantly lower the SPAP of both groups, while, "Ventavis" (iloprost solution for inhalation)nebulizing inhaled got a better efficacy(P< 0.05). To maintain the appropriate PT, patients of non-small left ventricle group need more Warfarin than the small left ventricle group(P<0.05).(4). The postoperative mechanical ventilation time and care unit check-in time of the small left ventricle group were longer than the non-small left ventricle group, the early postoperative complications were more than the non-small left ventricle group.(5). For the long-term effect, the SPAP of both groups decreased distinctly, there was a significant increase of the LVEDVI in small left ventricle group. The liver function, mortality, admission rate, thromboembolism,6MWT and cardiac functional grading were no significant difference between the two groups. To maintain the appropriate PT, there were no significant difference betweenthese two groups. The quality of life of patients with severe mitral stenosis got significant improvement after operation. There were no significant difference between the small left ventricle group and the non-small left ventricle group.Conclusion:Patients with small left ventricle associated with severe mitral stenosis had a poor condition when entering, there were more surgical risks. However, through the appropriate treatment during perioperative period, patients recovered well, and there were no significant difference between the two groups.