Changes of Left Ventricular Morphology and Contractile Function of Patients with Mitral Stenosis and Small Left Ventricle after Mitral Valve Replacement: A Systematic Review and Meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIAOWei-hua , LIUPeng , SHIJia-wei , WANGYin ,  DONGNian-guo

Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R.China;

Corresponding author：

DONGNian-guo, Email: dongnianguo@hotmail.com

Keywords：

Mitral stenosis; Small left ventricle; Mitral valve replacement; Therapeutic effect; Systematic review/meta-analysis

DOI：

10.7507/1007-4848.20160141

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Objective To evaluate the changes of left ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle after mitral valve replacement. Methods Studies on the changes of left ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle after mitral valve replacement were searched from the databases of Wangfang, VIP, CNKI, PubMed, Elsevier Science Direct, and Cochrane Library from establishment to January 2015. Quality of articles was evaluated. Relevant data were extracted from eligible studies to conduct meta-analysis. Mean differences (MD) of left ventricle end-diastolic volume index (LVEDVI), left ventricle end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS) between the preoperative and the postoperative value from eligible studies were analyzed and pooled, and their 95% confidence intervals (CI) were calculated. R2.15.3 software was applied for statistical analysis. Results Eight eligible studies involving 446 patients were analyzed in the study. The quality of included literature was high. The results of meta-analysis showed that LVEDVI and LVEDD increased by 14.51 ml/m² with 95%CI -22.78 to -6.25 (P<0.01) and 4.88 mm with 95%CI -10.85 to 1.09 (P=0.11) respectively at 2 weeks postoperatively compared with preoperative value. LVEF decreased by 3.05% with 95%CI -3.02% to 9.12% (P=0.32) while LVFS increased by 1.16% with 95%CI -4.83% to 2.50% (P=0.53) at 2 weeks postoperatively. Compared with preoperative value, LVEDVI and LVEDD markedly increased by 16.11 ml/m² with 95%CI -20.32 to -11.90 (P<0.01) and 10.56 mm with 95%CI -11.52 to -9.60 (P<0.01) respectively at 6 months postoperatively. LVEF and LVFS increased by 7.69% with 95%CI -17.18% to 1.8% (P=0.11) and 6.21% with 95%CI -10.07% to -2.36% (P<0.01) respectively at 6 months postoperatively compared with preoperative value. Conclusion Left ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle recovers well after mitral valve replacement.

Citation： QIAOWei-hua, LIUPeng, SHIJia-wei, WANGYin, DONGNian-guo. Changes of Left Ventricular Morphology and Contractile Function of Patients with Mitral Stenosis and Small Left Ventricle after Mitral Valve Replacement: A Systematic Review and Meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(6): 589-594. doi: 10.7507/1007-4848.20160141 Copy

1.	孙益峰, 王永武. 重症心脏瓣膜病的治疗进展. 同济大学学报(医学版), 2001, 22(2):33.
2.	张宝仁, 朱家麟, 主编. 人造心脏瓣膜与瓣膜置换术. 第2版. 北京:人民卫生出版社, 1999. 291-292.
3.	王寅, 董念国, 史嘉玮, 等. 大左心室心脏瓣膜病术后左心室形态及收缩功能变化的系统评价. 中国胸心血管外科临床杂志, 2013, 20(2):125-134.
4.	Wells G, Shea B, Connell D, et al. The Newcastle Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis.[2008-12-26]. http://www.ohri.ca/programs/clinical_epidemiology/oxford_web.ppt.July12,2006.
5.	徐志云, 张宝仁, 朱家麟, 等. 风心病二尖瓣狭窄合并小左心室的瓣膜替换术. 中华胸心血管外科杂志, 1997, 13(1):1-4.
6.	熊卫民, 龙建平, 盛斌, 等. 重度二尖瓣狭窄伴小左心室的外科治疗. 医学临床研究, 2004, 21(11):1295-1296.
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8.	华菲, 沈振亚, 肖接承, 等. 重度二尖瓣狭窄伴小左心室 28 例围手术期观察. 中国现代医药杂志, 2006, 8(12):47-49.
9.	张旭光, 陈智豫, 郝晓斌. 重度二尖瓣狭窄伴薄小左心室的外科治疗. 昆明医学院学报, 2008, 29(6):102-104.
10.	姜胜利, 高长青, 李伯君, 等. 小左心室患者瓣膜置换术后早期心脏形态及功能的变化. 中华外科杂志, 2009, 47(12):924-926.
11.	许咏冬, 章响艳, 涂韶松, 等. 小左心室患者二尖瓣手术综合策略. 浙江医学, 2010, 32(5):711-713.
12.	黄壮荣, 章海波, 马庆荣, 等. 体外膜肺氧合辅助外科治疗合并小左心室瓣膜病 13 例. 广东医学, 2010, 31(9):1171-1173.
13.	Carapetis JR, Steer AC, Mulholland EK, et al. The global burden of group A streptococcal diseases. Lancet Infect Dis, 2005, 5(11):685-694.
14.	白一帆, 主编. 成人心脏瓣膜病外科治疗20年回顾及危险因素变迁. 上海:第二军医大学. 2012. 1-6.
15.	Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet, 2009, 374:1271-1283.
16.	王云, 万荣华, 刘霞. 风湿性二尖瓣狭窄对左心室舒张末容量的影响. 西安交通大学学报:医学版, 2006, 27(3):309.
17.	马增山, 马胜军, 董铭峰, 等. 小左心室患者心瓣膜置换术的围手术期处理. 中国胸心血管外科临床杂志, 2005, 12(3):225-225.
18.	周旭毓, 夏旭. 医学信息定量综合的新方法-Meta 分析. 医学信息, 2002, 15(5):303-305.
19.	Gash AK, Carabello BA, Cepin D, et al. Left ventricular ejection performance and systolic muscle function in patients with mitral stenosis. Circulation, 1983, 67(1):148-154.
20.	Gaasch WH, Folland ED. Left ventricular function in rheumatic mitral stenosis. Euro heart j, 1991, 12(suppl B):66-69.
21.	马沛然, 杨亚超, 韩秀珍, 等. 左室射血分数和左室小轴缩短率对判断左心功能的价值. 山东医药, 1984, 11:012.
22.	隋东虎, 刘治全. 风湿性心脏病左心室心肌病理改变与术后心功能的关系. 中国循环杂志, 1999, 14(4):233-235.

1. 孙益峰, 王永武. 重症心脏瓣膜病的治疗进展. 同济大学学报(医学版), 2001, 22(2):33.
2. 张宝仁, 朱家麟, 主编. 人造心脏瓣膜与瓣膜置换术. 第2版. 北京:人民卫生出版社, 1999. 291-292.
3. 王寅, 董念国, 史嘉玮, 等. 大左心室心脏瓣膜病术后左心室形态及收缩功能变化的系统评价. 中国胸心血管外科临床杂志, 2013, 20(2):125-134.
4. Wells G, Shea B, Connell D, et al. The Newcastle Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis.[2008-12-26]. http://www.ohri.ca/programs/clinical_epidemiology/oxford_web.ppt.July12,2006.
5. 徐志云, 张宝仁, 朱家麟, 等. 风心病二尖瓣狭窄合并小左心室的瓣膜替换术. 中华胸心血管外科杂志, 1997, 13(1):1-4.
6. 熊卫民, 龙建平, 盛斌, 等. 重度二尖瓣狭窄伴小左心室的外科治疗. 医学临床研究, 2004, 21(11):1295-1296.
7. 滕和志, 王向丽, 秦春新, 等. 36 例小左心室患者二尖瓣置换治疗体会. 中国医药, 2006, 1(4):232-233.
8. 华菲, 沈振亚, 肖接承, 等. 重度二尖瓣狭窄伴小左心室 28 例围手术期观察. 中国现代医药杂志, 2006, 8(12):47-49.
9. 张旭光, 陈智豫, 郝晓斌. 重度二尖瓣狭窄伴薄小左心室的外科治疗. 昆明医学院学报, 2008, 29(6):102-104.
10. 姜胜利, 高长青, 李伯君, 等. 小左心室患者瓣膜置换术后早期心脏形态及功能的变化. 中华外科杂志, 2009, 47(12):924-926.
11. 许咏冬, 章响艳, 涂韶松, 等. 小左心室患者二尖瓣手术综合策略. 浙江医学, 2010, 32(5):711-713.
12. 黄壮荣, 章海波, 马庆荣, 等. 体外膜肺氧合辅助外科治疗合并小左心室瓣膜病 13 例. 广东医学, 2010, 31(9):1171-1173.
13. Carapetis JR, Steer AC, Mulholland EK, et al. The global burden of group A streptococcal diseases. Lancet Infect Dis, 2005, 5(11):685-694.
14. 白一帆, 主编. 成人心脏瓣膜病外科治疗20年回顾及危险因素变迁. 上海:第二军医大学. 2012. 1-6.
15. Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet, 2009, 374:1271-1283.
16. 王云, 万荣华, 刘霞. 风湿性二尖瓣狭窄对左心室舒张末容量的影响. 西安交通大学学报:医学版, 2006, 27(3):309.
17. 马增山, 马胜军, 董铭峰, 等. 小左心室患者心瓣膜置换术的围手术期处理. 中国胸心血管外科临床杂志, 2005, 12(3):225-225.
18. 周旭毓, 夏旭. 医学信息定量综合的新方法-Meta 分析. 医学信息, 2002, 15(5):303-305.
19. Gash AK, Carabello BA, Cepin D, et al. Left ventricular ejection performance and systolic muscle function in patients with mitral stenosis. Circulation, 1983, 67(1):148-154.
20. Gaasch WH, Folland ED. Left ventricular function in rheumatic mitral stenosis. Euro heart j, 1991, 12(suppl B):66-69.
21. 马沛然, 杨亚超, 韩秀珍, 等. 左室射血分数和左室小轴缩短率对判断左心功能的价值. 山东医药, 1984, 11:012.
22. 隋东虎, 刘治全. 风湿性心脏病左心室心肌病理改变与术后心功能的关系. 中国循环杂志, 1999, 14(4):233-235.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Changes of Left Ventricular Morphology and Contractile Function of Patients with Mitral Stenosis and Small Left Ventricle after Mitral Valve Replacement: A Systematic Review and Meta-analysis

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