Heart valve replacement for giant left ventricle: Clinical analysis of 138 cases / 医学研究生学报

ABSTRACT

Objective: Giant left ventricle is one of the important dangerous factors impacting the results of valve replacement operation.In order to improve the efficiency of operation,we summarized our experience in valve replacement surgery for patients with giant left ventricle(LVEDD ≥ 7.0 cm).Methods: We retrospectively analyzed the clinical data of 138 cases of giant left ventricle treated by valve replacement operation in our hospital from June 1996 to April 2008.The preoperative left ventricular end diastolic dimension(LVEDD),left ventricle end systolic dimension(LVESD),left ventricular ejection fraction(LVEF) and left ventricular fractional shortening(LVFS) were 7.38-10.51 cm(mean 7.98?0.39),5.20-7.93(mean 5.88 ? 1.03),0.21-0.66(mean 0.43 ? 0.11) and 0.10-0.45(mean 0.25 ? 0.07),respectively.Eighty-nine of the patients had the heart function(NYHA) of class Ⅲ,and the other 49 class Ⅳ.Mitral valve replacement(MVR) was performed for 57 cases,aortic valve replacement(AVR) for 26,double valves replacement(DVR) for 40,and Bentall operation for the other 15.Meanwhile,78 of them underwent tricuspid valve plasty(TVP),and another 17(LVEDD ≥8.5 cm and LVEF ≤ 25%) partial left ventriculectomy(PLV).Results: The early postoperative mortality rate was 5.8%,mainly due to postoperative multiple organ failure,severe low cardiac output syndrome and ventricular fibrillation.Compared with the preoperative data,postoperative echocardiography showed that LVEDD and LVESD were decreased slowly at 2 weeks,and LVEF and LVFS significantly improved at 6 months.In the 17 patients who underwent PLV,LVEDD and LVESD were significantly reduced at 2 weeks,and LVEF and LVFS markedly improved.Conclusion:The key to the efficiency of valve replacement for giant left ventricle was proper choice of the blood containing stop-beating fluid during the operation,preserving the posterior valve of the mitral valve and the structure beneath it,shortening aortic cross-clamping time as much as possible,and perioperative prevention and management of arrhythmia.The short-term effect of valve replacement with simultaneous PLV is satisfactory,while its long-term effect is yet to be further investigated.