Study of surgical treatment for mitral regurgitation associated with dilated left ventricle

doi:10.13498/j.cnki.chin.j.ecc.2015.01.08

Abstract：Objective To report the surgical outcome of mitral valve surgery for isolated chronic mitral insufficiency with se?verely dilated left ventricle ( LV) . Methods Between January 2000 and December 2012, 55 patients ( 35 male and 20 female) with a mean age of (40.5±15.1) years, underwent MVR or MVP at PLA general Hospital. Rheumatic MR was found in 19 cases (34.5%), congenital MR in 12 cases (21.8%)and infectious MR in 1 cases (1.9%). 17 patients were in NYHA functional class II, 34 in classⅢand 4 in classⅣ. The C/T ratio was 0.71±0.16 on chest x-ray. The clinical course was 0.3-38 (19.5±11.3) years. Electrocardio?gram ( ECG) showed 33 patients( 60%) had atrial fibrillation. Echocardiogram( UCG) showed severe or moderate MR and LV hypertro?phy in all patients. LVDD was:65.0-91.0 (71.6±5.5) mm;Left ventricular end-systolic dimension (LVESD) was 45.6-75.2 (54.6± 5.6) mm;Left ventricular end-diastolic volume index (LVEDDI) was 28.8-68.3 (42.5±7.5) mm/m2;Left ventricular end-diastolic volume index (LVEDVI) was 21.8-50.0 (32.4±6.3) mm/m2;Left atrial diameter was 43.0-110.0 (67.9±15.7) mm;Ejective frac?tion was 30.0%-79.0% (59.5±10.1)%;Interventricular septum was 6-13(10.0±1.5) mm. Results Two of 55 cases died in the peri-operative period (3.63%). Two weeks after surgery the UCG showed a reduction of left ventricle diastole diameter (LVEDD)from (71.6±5.5) to (58.1±7.6) mm( P<0.001).A total of 38 cases (71.69%) were successful followed. In themean follow-up of 19-179 (98.41±50.29) months, 33 patients (86.4%) survived, with 10 patients in NYHAclass I, 20 in class II, 2 in class III, and 1 in class IV. 5 deaths(13.15%) were noted during the follow-up, including 3 (60%) cardiac death. The non-cardiac death?sincludeduremia and cerebral hemorrhage. The LVEDD further decreased from (58.1±7.6) to (50.0±7.8) mm after discharge ( P<0.001) . Conclusion Mitral valve replacement is indicated in patients with mitral insufficiency and severely dilated left ventricles, and the intervention has the potential to restore theLV volume.