Background-The incidence, determinants, and outcome of postoperative atrial fibrillation (AF) after surgery for mitral regurgitation(MR) are poorly defined but may have important implications for timing of mitral valv...Background-The incidence, determinants, and outcome of postoperative atrial fibrillation (AF) after surgery for mitral regurgitation(MR) are poorly defined but may have important implications for timing of mitral valve surgery. Methods and Results-In 762 patients in sinus rhythm with no AF history undergoing MR surgical correction, we examined the rates and prognostic implications of postoperative AF for early AF (within 2 weeks postoperatively) and late AF(> 2 weeks after surgery). During postoperative follow-up, 180 patients (24%) experienced new AF (early AF in 136 and late AF in 111). Isolated early AF without recurrence was observed in 69 patients characterized by high angina class and lower left ventricular ejection fraction but no significant left atrial (LA) enlargement. However, overall early AF predicted late AF: 62±5%of patients with early AF had late AF at 10 years compared with 9±1%of patients without earlyAF (P< 0.0001). Large LA size strongly and independently predicted early AF (P=0.01) and late AF (P=0.003). For late AF, the predictive value of an enlarged LA was cumulative to that of early AF. Postoperative AF was associated with an increased subsequently higher risk of stroke or congestive heart failure (adjusted risk ratio=1.46 [1.04 to 2.05], P=0.03). Conclusions-Postoperative AF is common after surgical correction of MR in patients with no prior history of AF and is associated with increased subsequent morbidity. LA enlargement is independently predictive of postoperative AF and as such, should be integrated into the clinical decision-making process in patients with MR.展开更多
Objective We sought to evaluate the medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. Methods We analyzed the cause, clinical presentation, outcome, and natural history of 60 patients w...Objective We sought to evaluate the medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. Methods We analyzed the cause, clinical presentation, outcome, and natural history of 60 patients with tricuspid regurgi tation caused by flail leaflets, a cause of mostly severe and organic tricuspid regurgitation, diagnosed by means of echocardiography between 1980 and 2000. Res ults The main cause was traumatic(62%). Clinical presentation was often severe: 57%were symptomatic, 33%had a history of congestive heart failure, and 40%ha d a history of atrial fibrillation. Compared with expected survival of the US ma tched population, excess mortality (39%±10%at 10 years or 4.5%yearly, P< .01 ) was observed. Even patients asymptomatic at presentation experienced high tric uspid related event rates (at 10 years, 75%±15%had symptoms or heart failure , atrial fibrillation, surgical intervention, or death). In those patients sever e enlargement of right sided chambers was predictive of poor outcome (at 5 year s: 86%±9%vs 39%±11%, P< .01) independent of cause(P=.31). The poor medical outcome was further confirmed by high event rates (69%±9%at 15 years) in the natural history beginning from the flails occurrence. Tricuspid operations we re performed in 33 patients (55%±7%at 5 years), with valve repair in 82%, lo w mortality(3%), and, despite frequently refractory atrial fibrillation, sympto matic improvement in 88%. Conclusion Tricuspid regurgitation caused by flail le aflets is a serious disease associated with excess mortality and high morbidity. Tricuspid valve repair can often be performed with low risk, allowing symptomat ic improvement. These results suggest that surgical intervention should be consi dered early in the course of the disease before the occurrence of irreversible c onsequences.展开更多
文摘Background-The incidence, determinants, and outcome of postoperative atrial fibrillation (AF) after surgery for mitral regurgitation(MR) are poorly defined but may have important implications for timing of mitral valve surgery. Methods and Results-In 762 patients in sinus rhythm with no AF history undergoing MR surgical correction, we examined the rates and prognostic implications of postoperative AF for early AF (within 2 weeks postoperatively) and late AF(> 2 weeks after surgery). During postoperative follow-up, 180 patients (24%) experienced new AF (early AF in 136 and late AF in 111). Isolated early AF without recurrence was observed in 69 patients characterized by high angina class and lower left ventricular ejection fraction but no significant left atrial (LA) enlargement. However, overall early AF predicted late AF: 62±5%of patients with early AF had late AF at 10 years compared with 9±1%of patients without earlyAF (P< 0.0001). Large LA size strongly and independently predicted early AF (P=0.01) and late AF (P=0.003). For late AF, the predictive value of an enlarged LA was cumulative to that of early AF. Postoperative AF was associated with an increased subsequently higher risk of stroke or congestive heart failure (adjusted risk ratio=1.46 [1.04 to 2.05], P=0.03). Conclusions-Postoperative AF is common after surgical correction of MR in patients with no prior history of AF and is associated with increased subsequent morbidity. LA enlargement is independently predictive of postoperative AF and as such, should be integrated into the clinical decision-making process in patients with MR.
文摘Objective We sought to evaluate the medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. Methods We analyzed the cause, clinical presentation, outcome, and natural history of 60 patients with tricuspid regurgi tation caused by flail leaflets, a cause of mostly severe and organic tricuspid regurgitation, diagnosed by means of echocardiography between 1980 and 2000. Res ults The main cause was traumatic(62%). Clinical presentation was often severe: 57%were symptomatic, 33%had a history of congestive heart failure, and 40%ha d a history of atrial fibrillation. Compared with expected survival of the US ma tched population, excess mortality (39%±10%at 10 years or 4.5%yearly, P< .01 ) was observed. Even patients asymptomatic at presentation experienced high tric uspid related event rates (at 10 years, 75%±15%had symptoms or heart failure , atrial fibrillation, surgical intervention, or death). In those patients sever e enlargement of right sided chambers was predictive of poor outcome (at 5 year s: 86%±9%vs 39%±11%, P< .01) independent of cause(P=.31). The poor medical outcome was further confirmed by high event rates (69%±9%at 15 years) in the natural history beginning from the flails occurrence. Tricuspid operations we re performed in 33 patients (55%±7%at 5 years), with valve repair in 82%, lo w mortality(3%), and, despite frequently refractory atrial fibrillation, sympto matic improvement in 88%. Conclusion Tricuspid regurgitation caused by flail le aflets is a serious disease associated with excess mortality and high morbidity. Tricuspid valve repair can often be performed with low risk, allowing symptomat ic improvement. These results suggest that surgical intervention should be consi dered early in the course of the disease before the occurrence of irreversible c onsequences.
