| BACKGROUND:Heart valves include aortic valve, mitral valve, tricuspid valve and pulmonary valve, which jointly form the dynamic structure of the heart and play an important role in maintaining the normal function of the atrium and ventricle. Good function of heart valve is the precondition to ensure our blood to flow forward in the body.While heart valve disease is worldwide main influencing factors leading to low quality of patients' life and even their early deaths.Among so many kinds of heart valve diseases, severe mitral stenosis with small left ventricle is a more complex disease in cardiac surgery valvular disease. Small left ventricle is one of the most important heart changes at the end-stage of mitral stenosis. Patients combined with Small left ventricle show higher incidence of postoperative complications and mortality rate than normal valvular disease. The main complications after surgery mainly contain low cardiac syndrome, malignant arrhythmia and pulmonary dysfunction syndrome, etc. In recent years, with the increase of people's perception of valvular disease, early treatment of disease as well as the update of surgical technique and disease management, the perioperative mortality rate of patients suffering from this disease has been significantly reduced.Little research of this kind disease abroad may be related to the early treatment of disease, while the disease trends to relatively more incidence in our country.Long-term follow-up suggests that early surgery after actively improving the function of the body state, a small left ventricular performance after hemodynamicchanges can be gradually corrected and even tend to be back to normal.Functional tricuspid regurgitation(Function Tricuspid Regurgitation, FTR)refers to the system with the increase in left ventricular filling pressure, gradually leading to increased pulmonary artery pressure, thus increasing the afterload of the right ventricle, so that abnormal right ventricular function and geometry abnormal tricuspid regurgitant jet after change appear. At present domestic and international research on the FTR mitral regurgitation caused by more, which is also more mature in the mechanism of occurrence and surgical treatment. However, at home and abroad for severe mitral stenosis(Severe Mitral Stenosis, SMS) FTR process combined with low left ventricular(Small Left Ventricle, SLV) caused by the presence of more controversial. However, such patients are more common in clinical practice, and studies suggest that it is generally after the forward load that is the result of increased resistance, but the mechanism is still not exactly. FTR earlier surgical treatment indications, methods and long-term prognosis remains unclear. We therefore carried out a certain amount of such summarized to provide a mechanism of some of its theoretical basis, provide a reference for clinical treatment. This study describes two parts:PART ONE:clinical treatment and follow-up results of patients have Severe mitral stenosis and a small left ventricleObjective: For SMS with SLE clinical prognosis and follow-up treatment status were lessons learned.Methods: Severe mitral stenosis and mitral valve area <0.8cm2 diagnosis, the use of a small left ventricular end-diastolic volume index ?60ml / m2 diagnostic criteria, screening with severe mitral stenosis and small left ventricle in patients with a total of 84 cases. Anesthesia cardiopulmonary bypass mitral valve replacement plus tricuspid annuloplasty, which concomitant left atrial thrombus cleared 46 cases.Postoperative complications and mortality statistics the number of patients, for patients discharged from hospital to clinic or telephone follow-up in the form of access to early postoperative(~ 3 months), after the mid-term(3 months to 2 years),after long-term(2 years improve ~) quality of life and living conditions, analysis of relevant factors postoperative prognosis and survival condition.Results: 1) patients with major complications after surgery is mainly concentrated in the low cardiac output syndrome, malignant arrhythmia, pulmonary dysfunction syndrome. 4 died early postoperative mortality rate is about 4.76%. 2)long-term postoperative survival rate is about 84.3%. Cause of death has focused on long-term right ventricular failure and pulmonary infection. 3) postoperative follow-up, early postoperative left atrial diameter is reduced significantly, no more than the size of the left ventricle did not change significantly. After 3 months to 6months, reduced LV gradually returned to normal size, visible March to June is a critical period of cardiac function recovery. The possibility of preoperative left ventricular ejection fraction in the high normal(LVEF?50) in patients with normal left ventricular size smaller than left ventricular dysfunction(LVEF <50) patients.Conclusion: 1) SMS merger SLV major postoperative complications were low cardiac output syndrome, malignant arrhythmia, pulmonary dysfunction syndrome, perioperative optimization can significantly reduce patient mortality. 2)positive patients after small left ventricle is recoverable. 3) long-term survival and quality of postoperative status, and preoperative and postoperative cardiac function in patients with right ventricular function recovery of closely related.PART TWO: Severe mitral stenosis and small left ventricle patients with functional tricuspid regurgitation clinical research.Objective: Summary SMS with SLE patients with FTR occurrence of different surgical methods and long-term postoperative recovery, the relative explore appropriate surgical approach.Methods: Collect SMS with SLE clinical data of 84 cases, grouped according to the degree of preoperative FTR, give different surgical treatment according to the actual situation. After regular follow-up of patients echocardiographic data, analyzed the situation and improve long-term patient factors affect the FTR.Results: 1) Analysis of test results in patients with preoperative echocardiography and the like. The incidence of preoperative FTR about 99%, linear Pearson correlation test analysis showed that patients sex and age does not constitute a relevant factor. Extent and degree of pulmonary hypertension FTR and right ventricular function decreased tricuspid annulus diameter expansion and otherfactors related to atrial fibrillation. 2) long-term postoperative improvement rate of about 89.3%, before considering a patient in cardiac functional status and intraoperative surgical treatment related.Conclusion: The degree of pulmonary hypertension in patients, decreased function of right ventricular, tricuspid annulus diameter expansion and atrial fibrillation are relevant factors leading to the occurrence of FTR. Preoperative cardiac function in good condition, and actively provide molding can effectively improve the FTR, and shaped into a ring is better than a simple line DeVega angioplasty. |
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