Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement

BACKGROUND Mitral regurgitation(MR)is commonly seen in patients with severe aortic stenosis(AS)undergoing aortic valve replacement(AVR).But the long-term implications of MR in AS are unknown.AIM To investigate MR’s impact on survival of patients undergoing surgical AVR for severe AS.METHODS Of the 740 consecutive patients with severe AS evaluated between 1993 and 2003,287 underwent AVR forming the study cohort.They were followed up to death or till the end of 2019.Chart reviews were performed for clinical,echocardiographic,and therapeutic data.MR was graded on a 1-4 scale.Mortality data was obtained from chart review and the Social Security Death Index.Survival was analyzed as a function of degree of MR.RESULTS The mean age of the severe AS patients who had AVR(n=287)was 72±13 years,46%women.Over up to 26 years of follow up,there were 201(70%)deaths,giving deep insights into the determinants of survival of severe AS who had AVR.The 5,10 and 20 years survival rates were 75%,45%and 25%respectively.Presence of MR was associated with higher mortality in a graded fashion(P=0.0003).MR was significantly associated with lower left ventricular(LV)ejection fraction and larger LV size.Impact of MR on mortality was partially mediated through lower LV ejection fraction and larger LV size.By Cox regression,MR,lower ejection fraction(EF)and larger LV end-systolic dimension were independent predictors of higher mortality(χ^(2)=33.2).CONCLUSION Presence of greater than 2+MR in patients with severe AS is independently associated with reduced survival in surgically managed patients,an effect incremental to reduced EF and larger LV size.We suggest that aortic valve intervention should be considered in severe AS patients when>2+MR occurs irrespective of EF or symptoms.

Rheumatic Aortic Valve Disease with Mitral Stenosis—A Case Report

Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.

Transfemoral aortic valve implantation in the case of pre-existing mitral prosthesis and pure aortic regurgitation: A case report

BACKGROUND Transcatheter aortic valve replacement(TAVR)is recommended in patients with severe aortic stenosis who have high surgical risk.However,in the pre-existing mechanical mitral valve prosthesis and natural pure aortic regurgitation,TAVR is relatively contraindicated.In this report,we described one case of TAVR with native aortic regurgitation in the presence of mechanical mitral valve prosthesis.CASE SUMMARY A 64-year-old man with a medical history of mitral valve replacement had severe dyspnea and was symptomatic even at rest for 3 mo.His echocardiography showed severe native pure aortic regurgitation.His euroscore was 15.A TAVR procedure with an evolut R was planned.A 34 mm evolut R was placed by transesophageal echocardiography.The mitral prosthesis was functioning normally,and mild-moderate paravalvular leakage was evident by transesophageal echocardiography.The patient recovered without any complication.At 1 mo follow up,the patient was well,and no paravalvular leakage was noted.CONCLUSION TAVR for pure aortic regurgitation in the presence of prosthetic mitral valve can be a safe procedure.

Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis： a new paradigm for the heart team decision making

Background Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replace- ment （AVR） or transcatheter aortic valve implantation （TAVI）, in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty （BAV） as a bridge-to-decision （BTD） in selected high-risk patients. Methods Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade 〉 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. Results Mean logistic European System for Cardiac Operative Risk Evaluation （EuroSCORE） was 23.5%±15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% （0.5% major; 3.5% minor）. Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment （25.4% for AVR; 47.2% for TAVI）： 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. Conclusions Balloon aortic valvuloplasty can be considered as bridge-to- decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment.

Assessment of mitral valve reserve capacity before and after percutaneous balloon valvuloplasty with isoproterenol stress echocardiography

Objective: To explore whether successful valvuloplasty increases mitral valve reserve capacity in patients with mitral stenosis. Methods: Thirty-eight patients with pure rheumatic mitral stenosis underwent isoproterenol stress echocardiography before and after successful percutaneous balloon valvuloplasty. The mitral valve area (by direct planimetry of two-dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M-mode echocardiography) were measured at rest and under isoproterenol infusion to achieve heart rate of different stages. Results:Between the measurements before and after valvuloplasty, significant differences were observed in the mitral valve area (0. 91±0. 28 vs 1. 87±0. 23 cm2, P<0. 01), mean transmitral pressure gradient (12. 5±6. 3 vs 3. 9±1. 9 mmHg, P<0. 01) and cardiac output (3. 93±1. 44 vs 4. 73±1. 01 L/min, P<0. 05) at rest. Before valvuloplasty, the mean transmitral pressure gradient increased significantly (P<0. 01) as heart rate increased, but there were no significant differences in the measurements of mitral valve area and cardiac output (both P>0. 05). In contrast, there was a significant increase after valvuloplasty in the mean transmitral pressure gradient (P<0. 01), but both mitral valve area and cardiac output further increased (both P< 0. 01) as heart rate increased. Moreover, valvuloplasty decreased the mean transmitral pressure gradient at peak heart rate from 23. 0±4. 5 to 7. 75±2. 30 mmHg (F<0. 01) under submaximal stress. Conclusion: Successful percutaneous balloon valvuloplasty soon causes a significant increase of mitral valve reserve capacity in patients with mitral stenosis, which is conspicuously manifested under condition of hemodynamic stress. Stress echocardiography provides a safe, feasible and non-invasive means of assessing the reserve capacity.

Isoproterenol Stress Echocardiography in Assessing Mitral Valve Area Reserve before and after Percutaneous Balloon Valvuloplasty

Objective To determinewhether successful valvuloplasty causes an increase of mitral valve area reserve in patients with mitral stenosis, isoproterenol stress echocardiography was used to compare mitral valve area and hemodynamic changes between pre - and post - valvuloplasty under conditions of increased cardiac work. Methods Thirty-eight patients with pure rheumatic mitral stenosis who had received successful percutaneous balloon valvuloplasty underwent isoproterenol stress echocardiography pre- and post - valvuloplasty. Mitral valve area (by direct planimetry of two - dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M-mode echocardiography) were measured at rest and under isoproterenol stress to achieve heart rate of different stages. Results Mitral valve area (0.91±0.28 to 1.87±0.23 cm2, P<0. 01), mean transmitral pressure gradient (12. 5±6. 3 to 3. 9± 1. 9 mmHg, P < 0. 01) and cardiac output (3. 93± 1. 44 to 4. 73±1. 01 L/min, P < 0. 05) at rest between pre - and post - valvuloplasty were significantly different. Pre - valvuloplasty, as heart rate increased under stress, mean transmitral pressure gradient increased significantly ( P < 0. 01), but there were no significant differences in the measurements of mitral valve area and cardiac output (both P>0. 05) . In contrast, as heart rate increased post-valvuloplasty, there was a significant increase in mean transmitral pressure gradient (P<0.01), but both mitral valve area and cardiac output further increased significantly (bothP<0. 01) . Moreover, valvuloplasty decreased mean transmitral pressure gradient at peak heart rate from 23. 0±4. 5 to 7. 75 ± 2. 30 mmHg ( P < 0. 01) under submaximal stress. Conclusions Successful percutaneous balloon valvuloplasty soon causes a significant increase of mitral valve area reserve in patients with mitral stenosis, which is markedly manifested under conditions of hemodynamic stress. Stress echocardiog-raphy provides a safe, feasible and non-invasive means of assessing this reserve capacity.

The perioperative treatments of severe rhumatic heart disease with valve insufficiency

Objective To study the perioperative treatments for severe rheumatic heart disease with valve insuffciency. Methods Group 1 ( n = 25 ): mitral or/and arotic valve insufficiency, group 2 ( n = 17): valve stenosis and group 3 ( n = 14): simple congenital heart diseases. The load- independent index-end systolic elastance (Ees), pre-load recruited stroke work ( PRSW ), and the quantitive analyses of myocardial ultrastructure were observed and analyzed pre- and post-operatively. Results Ees was lower after operation than before operation in group 1, and it was a bit lower after operation in group 2. PRSW was significantly lower after operation than before operation in group 1, and it was similar before and after operation in group 2. The pre-load before operation and after-load after operation in group 1 increased. Vc%, Vvmyo% and Vvmit% were significantly lower in group 1 than in group 2. Ejection fraction (EF) was significantly lower after operation than before operation in group 1, and it was similar

THE EFFECTS OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY ON PULMONARY FUNCTION OF RHEUMATIC HEART DISEASE

Many papers have demonstrated that perctaneous transvenous nitralcolnmissurotomy（PTMC）can improve patterns’ heart function.The aim of thisresearch is to confirm the effect of PTMC on pulmonary function of rheumaticheart disease.PTMC was performed in 40 mitral stenosis patients according toInoue’s method.Left atrium mean pressure（LAMP）,left ventricular diastolicend pressure（LVDEP）,mean pressure gradient across the mitral valve（MVG）and right ventricular systolic prossure（RVSP）were measured immediatelybefore and after dilatation ofmitral valve,Pulmonary function,including VCFEV10/FVC、TLC、RV/TLC/、V50、V25 as percent predicted valuerespectively(VC%、FEV10/FVC%、TLC%、RV/TLC%、V50%,、V25%)were also dtermined in one week before and after PTMC,All cardiac pressureindexes and mitral valve area（MVA）were improved（P【0.01）and dates ofVC%,V50% were higher（from 76.54、79.59 to 84.33.93.29）andRV/TLC% was lower（from 147.12 to 129.82）dramstically（P【0.01）after PTMCFEV10/FVC%、TLC% and V25% were normal before PTMC and did notchange clearly.From this datas,we concluded that the patients suffered fromrheumatic mitral stenosis had clear decrease in pulmonary function and PTMCcould improve it obviously.

A PROSPECTIVE STUDY OF PATIENT-RELATED FACTORE INFLUENCING THE EFFICACY OF PERCUTANEOUS BALLOON CATHETER MTRAL VALVULOPLASTY BY A SET OF MODIFIED ECHOCARDIOGRAPHIC SCORE IN 115 SUBJECTS

The goal of the present study was to determine whether the patient-relatedfactors such as mitral valve morphological features influence the efficacyof percutaneous balloon catheter mitral valvuloplasty(PBMV)with Inoueballoon catheter,A set of modified echocardiographic total score(ETS),in which each score was assigned for each mitral valve morphologicalfeature such as valvular mobility,thickening,calcification or subvalvularthickening on a scare ranging from 1 to 4,used for a prospective cohortstudy of different fiTS in 115 subjects with mitral stenosis hut withoutsignificant mitral regurgitation.It was found that the efficacy of PBMVafter the procedure was significantly better in the low ETS(≤8 points)group(n=61,included 43 women;ages 18 to 57 years,mean 39)than inthe high ETS(】8 points) group(n=54,included 37 women;ages 17 to 58years,mean 40)in mitral valve area (2.32+0.46 cm^2vs 1.87±0.37cm^2,p【0.01),mean left atrial pressure(12±5 mmHg vs 18±7 mmHg,p【0.01),mean mitral valve pressure gradient(4±1 mmHg vs 10±2 mmHg,p【0.01),and left atrial dimension(34.9±5.2mm vs 41.2±6.9 mm,p【0,01).In the low ETS group,mitral valve area was 2.30±0.45 cm^2(NS)and leftatrial dimension was 35.2±5.5mm(NS)at 12-30(24±7)monthsfollow-up.In contrast,in the high ETS group,mitral valve areadecreased to 1.58±0.36 cm^2(p【0.01)and left atrial dimension incresed to45.2±7.4mm(p【0.05) at 12-36 months follow-up.In addition,restenosiswas demonstrated in 12 of 54 patients(22%)with a high ETS but only in2 of 61 patients(3%.p【0.01) with a low ETS at follow-up.Thus,thepatients with a morphological suitable valve for PBMV or a low ETS mayget a better efficacy from PBMV,and ETS mey be very useful in selectingpatient for the procedure.

PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY:EXPRIENCE OF 182 CASES

Objective:To evaluate the clinical results of pcrcutancous balloon mitratvalvuloplasty(PBMV)in patient with rheumatic nlitral stenosis.Materials andMethods:one hundred and eighty-two patients with rheumatic mitral stenosis(MS)have been Irented by PBMV since 1995.There were 30 males and 152females,aged 38.6+8.0 years.Atrial fibrillation occurred in 42 paticnts andsinus rhythm in 140 patients,including 18 patients wilh restenosis closedcommissurotomy and 8 patients with thrombus in the left atrial appendage bylaking a small dose of Warfarin(3mg/d)for 4-6 months.63 patients hadminimal mitral regurgitation,26 patients had minimal aortic valve stenosis onregurgitation.The balloon diameter was from 25mm to 28mm.PBMV wasperformed using tbe single balloon Inoue technique.Results:PBMV for 179 patients with MS were successfully performde AfienPBMV the mean Ien atrial pressure decreased from 36+11 mmllg to 12+4mmHg(P【0.001),the mean mitral value gradie(MVG)decreased from 32+6 mmHg to 9+5mmHg(P【0.001).the mean mitral valoe area incrensed from0.89±0.32 cm^2 lo 1.92±0.43 cm^2(P【0.001)the mean pulinonary arterypressure dropped from 54±26 mmHg to 32±14 mmHg(P【0.001).the mcanIen atrial diameler decreased(LAD) from 48 mm to 43 mm(P【0.001).symptomatic improvement occurred in 178 patients with severecolnplicatins.including one palient wilh.severe regurgitation of mitral valvedue to valve lear.another potienl with acute endovarditis there were no deatlor thronlhoembolic complications in all paticnts.Conclusion:The results suggest that PBMV is effective therapy for thepatients with mitral stenosis,the method is also of first choice for thealing MSwith cxcellent results,the procedure is very safely with high success rele and afew complications.

功能性二尖瓣反流在二叶式主动脉瓣重度狭窄患者经导管主动脉瓣置换术后的转归分析

目的探讨先天性二叶式主动脉瓣(bicuspid aortic valves,BAV)分型与功能性二尖瓣反流(functional mitral regurgitation,FMR)转归的关系及影响FMR改善的因素。方法回顾性分析2018年6月至2022年9月复旦大学附属中山医院收治的接受经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗的BAV重度主动脉瓣狭窄(aortic valve stenosis,AS)合并FMR患者,比较不同BAV患者的基线信息及影像学资料,分析其对FMR改善的影响。根据FMR是否改善分组,应用Logistic回归分析影响FMR转归的因素。结果共纳入100例行TAVR的患者,其中二叶瓣0型49例,二叶瓣1型51例。相比二叶瓣1型患者,二叶瓣0型患者年龄较小[(72.78±6.09)岁vs.(77.00±8.35)岁,P=0.050],男性比例偏低(47%vs.73%,P=0.009),BMI偏高[23.19±2.62)kg/m^(2)vs.(21.99±3.13)kg/m^(2),P=0.041],二叶瓣0型组主动脉瓣关闭不全反流发生率较低(69%vs.92%,P=0.040)。相比非改善组,改善组有更低的冠心病发病率(5%vs.18%,P=0.042),以及更高的肺动脉高压发病率(20%vs.2%,P=0.007);改善组左室舒张末期内径较大[(51.98±6.74)mm vs.(48.04±7.72)mm,P=0.009],主动脉瓣口最大流速更高[(4.86±0.95)cm/s vs.(4.47±0.75)cm/s,P=0.023]。Logistic回归分析结果表明,BAV患者术前肺高压、左室舒张末期内径以及瓣口最大流速是TAVR术后FMR改善的影响因素。结论二叶瓣0型与二叶瓣1型患者TAVR术后FMR改善率无显著差异。对于BAV狭窄患者,术前肺高压、左室舒张末期内径较大、主动脉瓣口最大流速更快与更高的FMR改善率相关。

重度主动脉瓣狭窄合并二尖瓣反流的诊治现状

重度主动脉瓣狭窄(AS)合并二尖瓣反流(MR)并不少见。目前经导管主动脉瓣置换术已成为重度AS的主要治疗方式,经导管二尖瓣置换/修复用于治疗MR的技术也日趋成熟。重度AS合并MR这一群体逐渐受到关注,了解这类患者的病理生理改变、AS解除后MR的变化及其对预后的影响,有助于合理地选择治疗方案。

Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

Background： Tricuspid regurgitation （TR） is frequently associated with severe mitral stenosis （MS）, the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty （PBMV） procedure in rheumatic heart disease patients with mitral valve （MV） stenosis and tricuspid valve regurgitation. Methods： Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV： MV area （MVA）, TR area （TRA）, atrial pressure and diameter, and pulmonary artery pressure （PAP）. The patients were followed for 6 months to 9 years. Results： After PBMV, the MVAs increased significantly （1.7 ± 0.3 cm2 vs. 0.9 ± 0.3 cm2, P 〈 0.01）; TRA significantly decreased （6.3 ± 1.7 cm2 vs. 14.2 ± 6.5 cm2, P 〈 0.01）, right atrial area （RAA） decreased significantly （21,5 ± 4.5 cm2 vs. 25.4 ± 4.3 cm〈 P 〈 0.05）, TRA/RAA （%） decreased significantly （29.3 ± 3.2% vs. 44.2 ± 3.6%, P 〈 0.01）. TR velocity （TRV） and TR continue time （TRT） as well as TRV - TRT decreased significantly （ 183.4± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P 〈 0.01 ; 185.7 ± 13.6 ms vs. 238.6 ±l 1.3 ms, P 〈 0.01 ; 34.2 ±5.6 cm vs. 60.7 ± 8.5 cm, P 〈 0.01, respectively）, The postoperative left atrial diameter （LAD） significantly reduced （41.3 ± 6.2 mm vs. 49.8± 6.8 mm, P 〈 0.01） and the postoperative right atrial diameter （RAD） significantly reduced （28.7 ±5.6 mm vs. 46.5 ± 6.3 mm, P 〈 0.01 ）; the postoperative left atrium pressure significantly reduced （ 15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P 〈 0.01 ）, the postoperative right atrial pressure decreased significantly （ 13.2 ±2.4 mmHg vs. 18.5 ±4.3 mmHg, P 〈 0.01 ）. The pulmonary arterial pressure decreased significantly after PBMV （48.2 ± 10.3 mmHg vs. 60.6 ±15.5 mmHg, P 〈 0.01）. The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years （average 75± 32 months）, 2 patients with severe regurgitation died （1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively）, 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative （1.4 ± 0.4 cm2 vs. 1.7 ±0.3 cm2, P 〈 0.05）; LAD slightly increased compared with the postoperative （45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P 〈 0.05）, RAD slightly also increased compared with the postoperative （36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P 〈 0.05）, but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant （P 〉 0.05）. The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative （P 〉 0.05）, the remaining patients without serious complications. Conclusions： PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.

Valvular and perivalvular involvement in patients with chronic kidney disease

Mitral annular calcification (MAC) and aortic valve calcification (AVC) are the most common valvular and perivalvular abnormalities in patients with chronic kidney disease (CKD). Both MAC and AVC occur at a younger age in CKD patients than in the general population. AVC progresses to aortic stenosis and mild aortic stenosis progresses to severe aortic stenosis at a more rapid rate in patients with CKD than in the general population. The use of calcium-free phosphate binders in such patients may reduce the calcium burden in valvular and perivalvular structures and retard the rate of progression of aortic stenosis. Despite high rates of morbidity and mortality, the prognosis associated with valve surgery in patients with CKD is better than without valve surgery. Infective endocarditis remains an important complication of CKD, particularly in those treated with hemodialysis.

经导管主动脉瓣置入术对重度主动脉瓣狭窄合并不同程度二尖瓣返流患者的影响

目的分析经导管主动脉瓣置入术(TAVI)对主动脉瓣狭窄(AS)合并不同程度二尖瓣返流(MR)患者的影响。方法回顾性选取2020年4月至2023年5月就诊于河南省胸科医院重度主动脉瓣狭窄并行TAVI手术的患者180例,按照患者是否合并MR及MR严重程度分为A组(无返流+轻度返流)、B组(中度+重度返流)。比较两组术前与术后心脏结构及功能的变化,以及TAVI手术在两组患者中的效果差异。结果两组患者术后主动脉瓣最大跨瓣压差即主瓣峰压差(AVPG)、主动脉瓣跨瓣峰流速即主瓣峰流速(AVPV)较术前均有改善(P<0.05),但其改善在两组之间差异无统计学意义(P>0.05)。合并二尖瓣中重度返流组左心房内径(LAD)[39.00(37.00,42.00)mm]、左室舒张末期内径(LVEDD)[47.00(41.00,58.00)mm]、二尖瓣返流面积(MR)[2.90(2.40,4.70)cm^(2)]及NT-ProBNP[2567.80(1196.87,3344.90)pg/mL]均低于术前[41.00(38.00,48.00)mm]、[55.00(44.00,60.00)mm]、[7.60(5.10,11.00)cm^(2)]、[4649.05(2132.54,9333.30)pg/mL],差异有统计学意义(P<0.05),术后左心室射血分数(LVEF)50.00(42.00,61.00)高于术前45.00(35.00,62.00),差异有统计学意义(P<0.05)。结论TAVI可用于AS合并不同程度MR患者的治疗,合并中重度MR的患者依然可以从中受益。

Hypercoagulability existing in the local left atrium of patient with mitral stenosis

Objective To investigate the pathogenesis of thromboembolism in patients with mitral stenosis in a pre-thrombotic state.Methods The biochemical markers’ levels in plasma for platelet activity [soluble P-selectin (GMP-140)],states of thrombin generation [antithrombin Ⅲ (AT Ⅲ) and protein C (PC)],fibrinolysis [D-dimer (DD), plasminogen activator inhibitor 1 (PAI-1),tissue plasminogen activator (t-PA) and FDP] and von Willebrand factor (vWF) were determined from blood specimens obtained from the femoral veins and arteries and the right and left atria of 43 consecutive patients (20 with atrial fibrillation and 23 with sinus rhythm) with mitral stenosis (MS),undergoing percutaneous mitral valvuloplasty. The same parameters were compared with those of 15 control subjects,who had no detectable heart disease,but with paroxysmal supraventricular tachycardia undergoing radiofrequency catheter ablation of the left accessory pathway through a transseptal passage. Results Blood from the left atrium contained an excessive amount of platelet activity,thrombin generation and fibrinolysis compared with the blood from the right atrium,and the femoral veins and arteries. However blood from the right atrium was much lower in these activities when compared with those from the left atrium,and the femoral veins and arteries in both groups. Compared with those in the control subjects, GMP-140 in the left atrium was significantly higher ( P <0.05) and AT Ⅲ was significantly lower ( P <0.05) in patients with MS. Compared with the patients with MS and spontaneous left atrial echocontrast (LASEC)≤1,the patients with MS and LASEC≥2 had significantly higher levels of GMP-140 in plasma ( P <0.05),and significantly lower levels of AT Ⅲ ( P <0.05) and PC ( P <0.01) levels in the left atrium. However, there were no significant differences between patients with atrial fibrillation and those with sinus rhythm regarding amounts of plasma coagulation markers in the left atrium. Univariate regression analysis revealed that LASEC was negatively correlated with plasma levels of blood from the left atria in the patients with MS. Conclusion Coagulability is increased in the left atria of patients with MS and is positively correlated with LASEC.

保留后瓣及瓣下结构对风湿性二尖瓣狭窄患者心肌应变力的影响

目的探究保留后瓣及瓣下结构对风湿性二尖瓣狭窄(RMS)患者心肌应变力的影响。方法选择2014年1月~2022年5月清远市人民医院收治的RMS患者(106例)为研究对象,根据术中是否保留后瓣及瓣下结构,分为保留组(56例)和未保留组(50例)。对比分析两组患者的临床资料、超声参数、心肌应变力以及术后并发症。结果与未保留组相比,保留组患者的ICU滞留时间、呼吸机辅助时间以及住院时间均更短(均P<0.01)。术后1个月,与未保留组相比,保留组患者的左心室舒张末期内径(LVEDD)以及左心室舒张末期容积(LVEDV)均更低(均P<0.01),左心室短轴缩短率(LVFS)(P<0.05)以及左心室射血分数(LVEF)(P<0.01)均更高。与未保留组相比,术后3个月保留组患者左心室心肌收缩期峰值应变(Ss)(基底段P<0.05,中间段P<0.01)以及收缩期峰值应变率(SRs)(基底段P<0.01,中间段P<0.05)均更高。与术前相比,未保留组患者术后1个月左心室心肌Ss均更低(均P<0.01),保留组患者术后1个月左心室心肌基底段与中间段Ss及SRs均更低(均P<0.01),术后3个月左心室心肌基底段与中间段Ss(均P<0.05)以及左心室心肌基底段与中间段SRs(均P<0.01)均更高。与术后1个月相比,未保留组患者术后3个月左心室心肌Ss以及左心室心肌SRs均更高(均P<0.05),保留组患者术后3个月左心室心肌Ss以及左心室心肌SRs均更高(均P<0.01)。与未保留组相比,保留组患者术后1个月并发症发生概率更低(P<0.05)。结论保留后瓣及瓣下结构的RMS患者ICU滞留时间、呼吸机辅助时间以及住院时间均显著缩短,有助于术后恢复心功能以及减少并发症,临床效果显著。