ABSTRACT
The main purpose of this study is to observe and analyze the characteristics and the clinical significance of long-term echocardiogram data in patients after mechanical aortic valve replacement operation. Fifty-five cases were recruited over 5 years after mechanical aortic valve replacement operation, with complete echocardiogram examination profiles. The 55 subjects were divided into predominate aortic stenosis group and predominate aortic regurgitation group, based on preoperative examinations. And another way of division was also carried out that according to the effective orifice area index (EOAI), the subjects were divided into three groups, i. e. , severe prosthesis-patient mismatch (PPM) group, moderate PPM group, and non PPM group. Characteristics of long-term echocardiogram data of the subjects were analyzed. Patients with aortic stenosis showed significantly decreased thickness of intraventricular septum and left ventricular posterior wall about half a year after operation (P < 0.05). Half a year after operation, patients with aortic regurgitation showed decreased left ventricular internal dimension diastole and left ventricular internal dimension systole, and increased ejection fraction (P < 0.05). Differences in mean aortic valve pressure gradient, forward blood flow across the aortic valves, and ejection fraction were not significant among those with severe PPM, moderate PPM, and non PPM groups (P > 0.05). Number of cases of ascending aorta dimension increased as time goes on and pathogenesis of other valve diseases. A conclusion could be drawn that the heart function of patients with aortic valve disease could be improved after mechanical aortic valve replacement operation, but pathologies in other valves and ascending aorta might be increased, and therefore periodical postoperative echocardiogram evaluation with long-term pharmaceutical therapy could be necessary.
Subject(s)
Humans , Aortic Valve Stenosis , General Surgery , Echocardiography , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation , Heart Ventricles , Postoperative Period , Systole , Treatment OutcomeABSTRACT
Objective To verify the feasibility and accuracy in the measurement of tricuspid valve annulus diameter(TVD) in the right ventricular outflow tract view.Methods Seventy five patients under the valve replacement surgery for the left heart valve lesions were divided into mild,moderate and severe group according to the severity of the regurgitation.The TVD was get on the apical four-chamber heart viewpreoperatively by transthoracic echocardiography(TTE),noted as TTE-TVD,meanwhile it was also get by the transesophageal echocardiography on the four-chamber view (TEE-TVD),right ventricular inflow (RVIT-TVD) and outflow tract view(RVOT-TVD).The changes of tricuspid regurgitation severtity was observed preoperatively.And the morphology of tricuspid annulus were observed using both real-time three dimensional transesophageal echocardiography (RT-3D TEE) and the quantitative software.Results Comparison in the groups:no statistically significant difference (P ＞0.05) was found between TTE-TVD,TEE-TVD and RVIT-TVD;while the RVOT-TVD was significant greater than that in the same group from other views (P ＜ 0.05).Comparison between the groups:no significant difference was found between mild and moderate regurgitation group on the same view.There was a significant difference of the TVD between the severe regurgitation group and the former two groups on each view(P ＜0.05).The severity of tricuspid regurgitation in intraoperative anesthesia was reduced.The saddle tricuspid ring evolved into the narrow planar structure on the RT-3D TEE.For the expansion of the annulus,it departure from the tricuspid septal leaflet.Conclusions TVD measured on the right ventricular outflow tract view reflect the maximum expansion of the tricuspid valve annulus diameter,and can effectively guide the decision-making choices of the surgeon.
ABSTRACT
Objective To evaluate the method of low-intensity anticoagulation therapy in the pregnant women who had received mechanical heart valve replacemant, and the effects of warfarin on the pregnant women and their fetus. Methods This retrospective study involved 56 pregnant women( 61 pregnancies)who had received mechanical heart valve replacement.Their pregnant status, delivery, and anticoagulation therapy were observed and followed-up between May 1986 and November 2009 at West China Hospital of Sichuan University. Results All patients took oral anticoagulant (warfarin) throughout pregnancy. The dose of domestic warfarin was ( 3.02 ± 0.85 ) mg/d ( in 42 cases), and the dose of imported warfarin was (2.84 ± 0.57 )mg/d (in 14 cases). The mean INR value of 401 samples from patients was 1.67 ±0.58. No thromboembolism or major hemorrhagic complications occurred. Minor bleeding occurred in 11 pregnancies. Forty-seven patients had term delivery, 7 had premature birth, 6 had spontaneous abortion, and 1 had intrauterine fetal death. Six newborns were born with low birth weight (2.3 ± 0. 5 ) kg, and no abnormal fetus was observed. Conclusion The low-intensity anticoagulation therapy with warfarin (at a dose of less than 5 mg/d) and a INR target of 1.5 to 2.0 was safe and convenient for the pregnant women,who had received mechanical heart valve replacement. The abnormalities rate of fetus was low.