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Background and ObjectivesMitral insufficiency (MI) is due to mitral valve ring, leaflets, chordate, papillary muscle disease, which lead to mitral regurgition. As the disease progresses, patients show the gradual heart failure. At present, the main form of the treatment for mitral regurgitation is surgical treatment, including mitral valvuloplasty and mitral valve replacement. For the patients with severe mitral valve disease and Mitral valve repair is ineffective often choose mitral valve replacement. Currently in our country, the main reason for the valve disease is still rheumatic and many patients choose mitral valve replacement. However, some patients have serious condition, heart dysfunction, seriously enlarged left ventricular when they seek medical treatment. At present, LVEDD＞70mm or LVESD＞50mm are referred to as a huge left ventricular valvular disease or severe valvular disease. Such patients have high risk of perioperative postoperative, mortality rates and poorly long-term recovery of ventricular function. This article aims to study perioperative changes in left ventricular function and to analyze the incidence of perioperative complications and the reasons for high mortality. Investigate the timing of operation for mitral regurgitation with large left ventricular. Subject and MethodsThere are 51 patients in this group. Preoperative, all patients were diagnosed mitral regurgitation by echocardiography. According to preoperative left ventricular end diastolic diameter, the patients were divided into two groups.,35 patients for A group, LVEDD＜70mm; 16 patients for B group, LVEDD＞70mm. Detailed record of the two groups patients age before surgery, cardiac function (NYHA), intraoperative aortic clamping time, CPB time, postoperative complications and treatment, postoperative mortality. Compare the changes of left ventricular end diastolic diameter, left ventricular end systolic diameter (LVESD), left atrial size (LAD), left ventricular shooting blood fraction (LVEF), left ventricular fractional shortening (LVFS) for two groups before surgery and 1 week,2 weeks,1 month,3 months after surgery, then analyze the causes of change. Use SPSS13.0 statistical software to analyze all data. P＜0.05 for significant difference.ResultsGroup A patients undergoing myocardial clamp time 61.29±19.84min; CPB time of 93.11±32.82min;); 3 patients died after operation (8.57%);5 cases of serious arrhythmia; re-thoracotomy in 2 cases; low cardiac output syndrome in 3 cases; complication rate was 28.5%; Group B patients undergoing myocardial clamp time 52.65±11.25min; CPB time of 104.23±24.14min); 3 patients died after operation (18.75%); 4 cases of serious arrhythmia, renal insufficiency hemodialysis in 1 case and pulmonary infection in 1 case. Complication rate of 37.5%.Compared with the preoperative, The LVEDD, LVESD and LAD have a reduced tendency after operation for two groups (P＜0.05) Each time point after operation compared with the previous point in time have a gradual decrease(P＜0.05).The LVEF, LVFS declined in 1 week and 2 weeks after operation (P＜0.05) and began to rise after 1 month’s time (P＜0.05). For two groups of patients after 3 months and after one month, the LVEF did not change significantly when compared (P＞0.05).Conclusions1. Mitral regurgitation with LVEDD＞70mm peri operative complications, mortality was significantly higher than mitral regurgitation with LVEDD＜70mm.2. Patients with mitral regurgitation showed a trend of decrease of LVEDD, LVESD and LAD after MVR. 3. Part of the patients, The LVEF, LVFS reduced within 1-2 weeks after MVR, the patients with LVEDD＞70mm were obvious.
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