Abstract： Objective To determine the influence of preoperative atrial fibrillation （AF） on midterm and longterm clinical outcomes of patients after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 1 029 patients who underwent MVR with or without tricuspid valve repair in Changhai Hospital， Second Military Medical University， from January 2000 to December 2005. According to the exclusion criteria， 621 patients were selected and divided into two groups depending on presence of preoperative AF. Those 395 patients with preoperative AF belonged to the AF group， including 134 males and 261 females with their average age of 51.1±11.5 years. Those 226 patients with preoperative sinus rhythm （SR） were in the SR group， including 82 males and 144 females with their average age of 48.2±14.1 years. Early postoperative outcomes， midterm and longterm mortality and morbidity of the two groups were compared. Results During 10 years of follow-up， there was no statistical difference in early postoperative mortality and morbidity between the two groups， but the incidence of late thromboembolism was significantly higher in AF group than that in SR group ［0.9‰ （31 patients/33 984 patient-months） vs. 0.4‰ （9 patients/21 151 patient-months）， χ2=4.26， P=0.039］. Ten-year survival rate in patients in AF group was significantly lower than that in SR group （83.2% vs. 92.7%， χ2=10.26， P=0.002）. Multivariate analysis identified preoperative AF ［HR=2.878， 95% CI （1.166，4.129）］， low left ventricular ejection fraction ［HR=0.948， 95% CI （0.917，0.981）］ ， and old age ［HR=1.073， 95% CI （1.038，1.109）］ as independent risk factors for late mortality after MVR. Apart from its influence on patient survival rate and incidence of thromboembolism， preoperative AF also had an adverse effect on left ventricular function， right ventricular function and tricuspid regurgitation. Conclusion AF is an independent risk factor for poor prognosis after MVR. Prognosis after MVR might be improved if surgery could be performed early when patients have predictive signs of AF such as multiple premature atrial contractions or left atrium enlargement.
Objective To study the clinical characteristics, therapy strategies and the outcomes of female patients with acute aortic dissection during late pregnancy and puerperal period. Methods We retrospectively analyzed the clinical data of 7 patients with acute aortic dissection during late pregnancy and puerperal period in Shanghai Changhai Hospital between August 2012 and June 2017. Five of the 7 patients were late stage pregnancy, 2 were puerperal period (1 at the postpartum night, 1 in 18 days after delivery). There were 6 patients of Stanford type A aortic dissection (85.7%), and 1 patient of type B aortic dissection (14.3%). The age of the patients ranged from 26 to 34 (30.8±3.1) years. Cardiac ultrasonography of patients with type A showed that the maximum diameter of the ascending aortas was 4.2–5.7 (4.7±0.6) cm, of which 2 patients were aneurysm of aortic sinus, 3 patients were with Marfan syndrome. Bentall procedure was conducted in 1 patient, Bentall+Sun’s surgery in 2 patients, ascending aorta replacement+Sun’s+coronary artery bypass grafting surgery in 1 patient, aortic root remodeling+ascending aorta replacement+Sun’s surgery in 2 patients. One patient with Stanford type B acute aortic dissection was performed with thoracic endovascular aortic repair (TEVAR) after cesarean section. Results Aortic blocking time ranged from 51 to 129 (85.5±22.9) min. Cardiopulmonary bypass time was 75–196 (159.0±44.0) min. Moderate hypothermic circulation arrest with selective cerebral perfusion time was 20–30 (23.8±3.5) min. All maternal and fetuses survived. The infant whose mother received aortic repair in early stage and then received cesarean section was diagnosed with cerebral palsy. Maternal and fetuses were followed up for 9 months to 4 years. During the follow up period, all the fetuses grew well except the cerebral palsy one, and all maternal recovered well. The patient who received aortic repair in the early stage, had a sigmoid rupture during cesarean section and was treated with sigmoid colostomy. Another patient with Stanford type A dissection was diagnosed as left renal vein entrapment syndrome after 2 years. Conclusion Type A aortic dissection is more common in late pregnancy and puerperal patients. And Marfan syndrome is a high-risk factor for acute aortic dissection in pregnancy women. Early and appropriate surgical treatment strategy based on the type of aortic dissection and gestational age are the key points to achieve good outcomes both for maternal and fetus.