Résumé
From February 1996 to May 1997, 18 patients underwent mitral valve repair for mitral regurgitation. There were 9 male and 9 female patients aged from 19 to 68 years (mean, 53). Thirteen patients were in New York Heart Association (NYHA) class III and IV. The cause of mitral regurgitation was degenerative in 12 patients, rheumatic in 5 patients and infective in 1 patient. Fifteen patients were in Carpentier's functional classification II, 2 patients in Carpentier's class III and 1 patient in Carpentier's class I. Surgical procedures included prosthetic ring annuloplasty (16 cases), rectangular resection of posterior leaflet (15 cases), chordal shortening (5 cases), triangular resection of anterior leaflet (2 cases), commissurotomy (2 cases), partial transposition of posterior leaflet (1 case). These procedures were combined in most patients. There was no operative death. These patients have been followed from 1 to 15 months, mean of 6.7 months. There was one late death resulted from low cardiac output following mitral valve replacement. The function of the repaired valve in other 17 patients has remained satisfactory during the observed interval. We consider that mitral valve repair is highly satisfactory in patients with mitral regurgitation.
Sujets)
Femelle , Humains , Mâle , Bas débit cardiaque , Classification , Coeur , Insuffisance mitrale , Valve atrioventriculaire gaucheRésumé
Total body water is increased after cardiopulmonary bypass resulting in tissue edema and organ dysfunction. Ultrafiltration has been used to reduce this accumulation of water. We have carried out a prospective randomized study in 17 children undergoing open heart surgery, comparing modified ultrafiltration (MUF) with nonfiltered controls. MUF was carried out for about 10 minutes after completion of cardiopulmonary bypass to a hematocrit 36~42%. Blood loss, blood transfused, hemodynamics, and laboratory data were recorded for 24 hours postoperatively. The results were analyzed using Mann-Whitney U test, comparing controls (n=7) to ultrafiltered (n=10). There was no death in each group. The mean filtrate volume (ml/kg) was 42 (30~68). Blood loss (ml/kg/24hr) was 14.5 mean (4.0~26.6) in controls versus 12.1 mean (6.0~21.5) in MUF (p>0.05) ; blood transfused (ml/kg/24hr) was 9.4 mean (6.0~36.3) in controls versus 3.4 mean (0~11.4) in MUF (p<0.05). There was rise in arterial blood pressure during MUF. Percent rise of systolic blood pressure was 4.2 (0~11.7) in controls versus 19.8 (7.0~36.9) in MUF (P=0.001). Percent rise of diastolic blood pressure was 10.0 (1.6~20.8) in controls versus 30.6 (5.8~73.3) in MUF (p<0.05). Platelet count, fibrinogen, and oncotic pressure rose after MUF. No complications directly attributable to the ultrafiltration were observed. Conclusively, MUF is safe, effective means of removing body water and beneficial to hemodynamics.