Study of multiple valve replacement in patients with giant left ventricle / 中华胸心血管外科杂志

Objective: To summarize the experience of valve replacement for multiple valve insufficiency in patients with giant left ventricle and the operative indication. Methods: Multiple valvular operations were performed in 62 patients with giant left ventricle between 1991 and 2002. Combined mitral and aortic valve replacement was performed in 56, tricuspid valve annuloplasty in 43, left atrium placation surgery in 12, and mitral valve replacement in 5. Results: The early postoperative complication and mortality rate were 45.2% and 17.7%, respectively .The late mortality rate was 6.5%. The main factors influencing the early surgical results were preoperative severe left ventricular enlargement (ESD ≥6.0cmand EDD ≥8.0cm) and systolic dysfunction (EF ≤0 40 and FS ≤0 25), perioperative ventricular fibrillation, postoperative low cardiac output and multiple organal failure. The main factors affecting long term survival were postoperative severe ventricular arrhythmia and left ventricular enlargement with depressed systolic performance. Conclusion: The keys to improve the early and late results of multiple valve replacement in these patients with giant left ventricle are the choice of optimum surgical timing, the proper management of the high risk factors mentioned above during perioperative and follow up periods.

Value of right ventricular ejection fraction in the preoperative risk evaluation for pulmonary resection / 中国肺癌杂志

<p><b>BACKGROUND</b>To evaluate the preoperative right ventricular ejection fraction (RVEF) as a predictor of postoperative complications after lung resection.</p><p><b>METHODS</b>RVEF was consecutively assessed in 254 patients before pulmonary resection by echocardiography. According to preoperative right ventricular function, the patients were divided into: group Ia (n=82, RVEF≥45%), group Ib (n=92,RVEF < 45%), group Ic (n=42, RVEF < 40%),and group Id (n=38, RVEF≤35%). Postoperative RVEF was detected again in 122 patients 3 weeks later after lung resection.</p><p><b>RESULTS</b>Preoperative RVEF of patients with postoperative complications was significantly higher than that of patitents without postoperative complications (P < 0.001). Among group Ia, Ib, Ic, and Id, there were significant differences in postoperative morbidities (P < 0.005). Patients with a preoperative RVEF less than 40% had a higher incidence of complications than those with RVEF over 40% (P < 0.005). Of the 122 patients, postoperative RVEF was remarkably lower than preoperative RVEF (P < 0.01).</p><p><b>CONCLUSIONS</b>The preoperative RVEF may be a predictor of postoperative complications for lung resection. RVEF higher than 40% is considered as a safe range for pneumonectomy.</p>