Long-term Characteristics and Clinical Significance of Echocardiogram in Patients after Mechanical Prosthesis Aortic Valve Replacement_Journal of Biomedical Engineering

Authors：

LIYongbo ¹ , TANGHong ² , ZHUXiliang ¹ ,  XIAOXijun ¹

1. Division of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Division of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

XIAOXijun, Email: xijunxiao@hotmail.com

Keywords：

aortic valve replacement; follow-up; echocardiography

DOI：

10.7507/1001-5515.20140058

Video：

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The main purpose of this study is to observe and analyze the characteristics and the clinical significance of long-term echocardiogram data in patients after mechanical aortic valve replacement operation. Fifty-five cases were recruited over 5 years after mechanical aortic valve replacement operation, with complete echocardiogram examination profiles. The 55 subjects were divided into predominate aortic stenosis group and predominate aortic regurgitation group, based on preoperative examinations. And another way of division was also carried out that according to the effective orifice area index (EOAI), the subjects were divided into three groups, i.e., severe prosthesis-patient mismatch (PPM) group, moderate PPM group, and non PPM group. Characteristics of long-term echocardiogram data of the subjects were analyzed. Patients with aortic stenosis showed significantly decreased thickness of intraventricular septum and left ventricular posterior wall about half a year after operation (P<0.05). Half a year after operation, patients with aortic regurgitation showed decreased left ventricular internal dimension diastole and left ventricular internal dimension systole, and increased ejection fraction (P<0.05). Differences in mean aortic valve pressure gradient, forward blood flow across the aortic valves, and ejection fraction were not significant among those with severe PPM, moderate PPM, and non PPM groups (P>0.05). Number of cases of ascending aorta dimension increased as time goes on and pathogenesis of other valve diseases. A conclusion could be drawn that the heart function of patients with aortic valve disease could be improved after mechanical aortic valve replacement operation, but pathologies in other valves and ascending aorta might be increased, and therefore periodical postoperative echocardiogram evaluation with long tem pharmaceutical therapy could be necessary.

Citation： LIYongbo, TANGHong, ZHUXiliang, XIAOXijun. Long-term Characteristics and Clinical Significance of Echocardiogram in Patients after Mechanical Prosthesis Aortic Valve Replacement. Journal of Biomedical Engineering, 2014, 31(2): 308-313. doi: 10.7507/1001-5515.20140058 Copy

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1. 陈孝平,石应康,邱贵兴,等.外科学[M].第6版.北京:人民卫生出版社,2005:509-518.
2. RAHIMTOOLA S H.The problem of valve prosthesis-patient mismatchp[J].Circulation,1978,58(1):20-24.
3. 刘文龙,王大成,朱建宝,等.主动脉瓣病变的外科治疗[J].内蒙古医学杂志,2011,43(10):1175-1176.
4. 张宝仁,邹良建,徐志云,等.风湿性瓣膜病二尖瓣与主动脉瓣置换术1154例长期效果分析[J].中华外科杂志,2003,41(4):243-246.
5. 黄劲松,黄克力,简旭华,等.50岁以上的主动脉瓣病变患者的外科治疗:附73例报告[J].南方医科大学学报,2012,32(2):258-260.
6. 王智伟,林柏松.心脏人工机械瓣膜置换术后出血原因分析[J].吉林医学,2011,32(4):718-719.
7. 姚泰.生理学[M].第6版.北京:人民卫生出版社,2005:197-214.
8. WALKER D K,BRENDZEL A M,SCOTTEN L N.The new St.Jude Medical regent mechanical heart valve:laboratory measurements of hydrodynamic performance[J].J Heart Valve Dis,1999,8(6):687-696.
9. JAMIESON W R,YE J,HIGGINS J,et al.Effect of prosthesis-patient mismatch on long-term survival with aortic valve replacement:assessment to 15 years[J].Ann Thorac Surg,2010,89(1):51-58.
10. BLAIS C,DUMESNIL J G,BAILLOT R,et al.Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement[J].Circulation,2003,108(8):983-988.
11. CHON L H.Cardiac surgery in the adult[M].3rd ed.New York:The McGraw-Hill Companies,2008:825-856.
12. DOMINIK J,ZACEK P.Heart valve Surgery[M].Berlin:Grada Publishing,2010:104-186.
13. LEVINSON J R,AKINS C W,BUCKLEY M J,et al.Octogenarians with aortic stenosis.Outcome after aortic valve replacement[J].Circulation,1989,80(3 Pt 1):149-156.
14. WESTABY S,HUYSMANS H A,DAVID T E.Stentless aortic bioprostheses:compelling data from the second international symposium[J].Ann Thorac Surg,1998,65(1):235-240.
15. DAVID T E,PUSCHMANN R,IVANOV J,et al.Aortic valve replacement with stentless and stented porcine valves:a case-match study[J].J Thorac Cardiovasc Surg,1998,116(2):236-241.
16. PIBAROT P,DUMESNIL J G.Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention[J].J Am Coll Cardiol,2000,36(4):1131-1141.
17. EDMUNDS L H Jr,CLARK R E,COHN L H,et al.Guidelines for reporting morbidity and mortality after cardiac valvular operations.The American Association for Thoracic Surgery,Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity[J].Ann Thorac Surg.1996,62(3):932-935.
18. ELAYDA M A,HALL R J,REUL R M,et al.Aortic valve replacement in patients 80 years and older.Operative risks and long-term results[J].Circulation,1993,(5 Pt 2):Ⅱ11-16.
19. NÖTZOLD A,HVPPE M,SCHMIDTKE C,et al.Quality of life in aortic valve replacement:pulmonary autografts versus mechanical prostheses[J].J Am Coll Cardiol,2001,37(7):1963-1966.
20. MOHTY D,MOHTY-ECHAHIDI D,MALOUF J F,et al.Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic position[J].Circulation,2006,113(3):420-426.
21. TASCA G,BRUNELLI F,CIRILLO M,et al.Impact of the improvement of valve area achieved with aortic valve replacement on the regression of left ventricular hypertrophy in patients with pure aortic stenosis[J].Ann Thorac Surg,2005,79(4):1291-1296.
22. RUEL M,AL-FALEH H,KULIK A,et al.Prosthesis-patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction:effect on survival,freedom from heart failure,and left ventricular mass regression[J].J Thorac Cardiovasc Surg,2006,131(5):1036-1044.
23. KOCH C G,KHANDWALA F,ESTAFANOUS F G,et al.Impact of prosthesis-patient size on functional recovery after aortic valve replacement[J].Circulation,2005,111(24):3221-3229.
24. HONG S,YI G,YOUN Y N,et al.Effect of the prosthesis-patient mismatch on long-term clinical outcomes after isolated aortic valve replacement for aortic stenosis:A prospective observational study[J].J Thorac Cardiovasc Surg,2012 Sep 6.[Epub ahead of print].
25. YOTTASURODOM C,NAMTHAISONG K,PORAPAKKHAM P,et al.Patient-prosthesis mismatch has no influence on in-hospital mortality after aortic valve replacement[J].J Med Assoc Thai,2012,95(Suppl 8):S64-S70.
26. GIRDAUSKAS E,DISHA K,BORGER M A,et al.Long-term prognosis of ascending aortic aneurysm after aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis[J].J Thorac Cardiovasc Surg,2012(12):01381-01385.

Journal of Biomedical Engineering

Long-term Characteristics and Clinical Significance of Echocardiogram in Patients after Mechanical Prosthesis Aortic Valve Replacement

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