Objective To conduct a systematic review to evaluate preoperative and postoperative changes of echocardiography indexes which reflect left ventricular morphology and contractile function after heart valve replacement of patients with valvular heart disease with giant left ventricle. Methods We electronically searched CBMdisc， VIP database，Wanfang database， CNKI database， PubMed and ScienceDirect from time of establishment of each database to June 2012 to identify literatures addressing heart valve replacement for patients with valvular heart disease and giant left ventricle. Quality of included literatures was evaluated， and relevant data were extracted to conduct meta-analysis. Preoperative and postoperative changes of echocardiography indexes of patients undergoing heart valve replacement were compared. R2.15.2 software was used for statistical analysis. Results Twelve retrospective cohort studies were included in this study involving 833 patients. The quality of included literature was relatively high. Meta-analysis showed that left ventricular end-diastolic diameter （LVEDD） at 2 weeks， 6 months， 1 year， 2 to 3 years postoperatively were reduced by 11.72 mm［95% CI （9.52，13.92）， P＜0.001］， 20.02 mm ［95% CI （18.28， 21.76）， P＜0.001］， 22.48 mm ［95% CI （19.55， 25.40）， P＜0.001］ and 24.69 mm ［95% CI （22.21， 27.18）， P＜0.001］ respectively compared with preoperative value. Left ventricularend-systolic diameter （LVESD） at 2 weeks， 6 months， 1 year， 2 to 3 years postoperatively were reduced by 7.74 mm ［95% CI （3.76， 11.72）， P＜0.001］， 15.54 mm ［95% CI （12.55， 18.54）， P＜0.001］， 18.84 mm ［95% CI （15.54， 21.14），P＜0.001］ and 21.02 mm［95% CI （17.67， 24.37）， P＜0.001］ respectively compared with preoperative value. Compared with preoperative value， left ventricular ejection fraction （LVEF） decreased by 7% at 2 weeks postoperatively ［95% CI （1%， 12%）， P=0.013］， increased by 9% at 6 months postoperatively ［95% CI （-14%， -3%）， P=0.002］， increased by 11% at 1 year postoperatively ［95% CI （-22%， 0%）， P=0.041］， and increased by 13% at 2-3 years postoperatively ［95% CI （4%， 21%）， P=0.004］. Compared with preoperative value， left ventricular fraction shortening （LVFS） decreased by 0.05 at 2 weeks postoperatively ［95% CI （0.03， 0.07）， P＜0.001］， increased by 0.02 at 6 months postoperatively ［95% CI （0.00， 0.04）， P=0.055］， increased by 0.03 at 1 year postoperatively ［95% CI （0.00， 0.06）， P=0.035］， and increased by 6% at 2-3 years postoperatively ［95% CI （0.02， 0.11）， P=0.008］. Conclusions LVEED and LVESD of patients with valvular heart disease and giant left ventricle continuously decrease after heart valve replacement， especially in the first 6 months postoperatively， and return to normal in 2 to 3 years. LVEF and LVFS decrease in the first 2 weeks postoperatively， then start to increase， are higher than preoperative values at 6 months， and return to normal in 2 to 3 years. Heart valve replacement is conducive for the recovery of left ventricular morphology and systolic function of patients with valvular heart disease and giant left ventricle.
Abstract： Objective To use tissue Doppler strain rate imaging to evaluate the impact of low dose dopamine and milrinone on systolic and diastolic function of the left ventricle of patients undergoing heart valve replacement. Methods Forty patients undergoing selective heart valve replacement in West China Hospital of Sichuan University between March and May 2011 were included in this study. All the patients were randomized into 2 groups with 20 patients in each group： milrione group and dopamine group. After anesthesia induction and before cardiopulmonary bypass setup， left ventricular ejection fraction （LVEF） was measured by echocardiography. Tissue Doppler strain rate imaging was used to measure the left ventricular lateral wall and midventricular segment from the four-chamber view， which was compared with Doppler parameters. Results LVEF， ratio of early-diastolic to end-diastolic velocity （E/A） of transmitral flow， ratio of mitral inflow velocity to early diastolic velocity in the annulus （E/Et） of both 2 groups were significantly different between before and after dopamine and milrinone administration （P＜0. 05）. In the milrinone group， 4 segments systolic peak velocity （Vs）， 1 segment early diastolic peak velocity （Ve）， 4 segments late diastolic peak velocity （Va）， 3 segments Ve/Va ratio， 2 segments systolic peak strain rate （SRs）， 2 segments late diastolic peak strain rate （SRa）， and 3 segments early diastolic peak strain rate SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0. 05）. In the dopamine group， 4 segments systolic peak velocity （Vs）， 1 segment Ve， 4 segments Va， 1 segment Ve/Va ratio， 2 segments SRs， 1 segment SRe， 1 segment SRa， and 1 segment SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0.05）. To compare the milrione group and dopamine group after medication administration， 2 segments Vs， 4 segments Va， 1 segment SRe， 1 segment SRa， 2 segments Ve/Va ratio， and 2 segments SRe/SRa ratio of the milrione group were significantly higher than those of the dopamine group （P＜0.05）， and 1 segment Vs， two segments SRs of the milrione group were significantly lower than those of the dopamine group （P＜0.05）. Conclusion Both milrinone and dopamine can improve left ventricular systolic function of perioperative patients undergoing heart valve replacement assessed by tissue Doppler strain rate imaging， while milrinone can improve the diastolic function of the left ventricle on the long axis more significantly.
Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.
Objective To investigate the risky factors of ventricular arrhythmias following open heart surgery in patients with giant left ventricle, and offer the basis in order to prevent it’s occurrence. Methods The clinical materials of 176 patients who had undergone the open heart surgery were analyzed retrospectively. There were 44 patients who had ventricular arrhythmia (ventricular arrhythmia group), 132 patients who had no ventricular arrhythmia as contrast (control group). The preoperative clinical data, indexes of types of cardiopathy, ultrasonic cardiogram, electrocardiogram and cardiopulmonary bypass (CPB) etc. were choosed, and tested by using χ2 test,t test and logistic regression to analyse the high endangered factors for incidence of ventricular arrhythmia after open heart surgery. Results Age≥55 years (OR=3.469), left ventricular enddiastolic diameter(LVEDD)≥80 mm (OR=3.927), left ventricular ejection fraction（LVEF）≤55% (OR=2.967), CPB time≥120min(OR=5.170) and aortic clamping time≥80min(OR=4.501) were the independent risk factors of ventricular arrhythmia. Conclusion Ventricular arrhythmia is a severe complication for the patients with giant left ventricle after open heart surgery, and influence the prognosis of the patients. Patient’s age, size of the left ventricle, cardiac function, CPB time and clamping time could influence the incidence of ventricular arrhythmias.
Objective To evaluate the left ventricular remodeling after valve replacement for valvular heart disease with giant left ventricle. Methods The clinical material of 92 patients with valvular heart disease and giant left ventricle after valve replacement was retrospectively reviewed. The results of ultrosonic cardial gram（UCG） and the changes of cardiac function before and after operation were compared. Results There was no operative death. The value of left ventricular end-diastolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD）, left atrial dimension （LAD）, left ventricular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS）, stroke volume （SV） and cardiothoracic ratio in 2 weeks and 2 months after operation were more decreased than those before operation（P〈0. 05）. The value of LVEDD and LAD in 2 months after operation were much more decreased than those in 2 weeks after operation （P〈0. 05）. The cardiac function in early stage after operation was more decreased than that before operation,but the cases of cardiac functional class Ⅱ （38 cases, 41.3% ） in 2 months after operation was significantly more than those before operation （5 cases, 5.4 % ）. Conclusions The early effect of left ventricular remodeling is significant for valvular heart disease with giant left ventricle after valve replacement. The diameter of left ventricle and left atrial are significantly decreased after operation. The protection for cardiac function should be carefully taken in order to prevent the occurrence of complication after operation.
ObjectiveTo investigate clinical outcomes and risk factors of patients with valvular heart disease (VHD) and giant left ventricle undergoing heart valve replacement (HVR). MethodsClinical data of 144 VHD patients with giant left ventricle who underwent HVR in Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from January 2009 to December 2012 were retrospectively analyzed. There were 116 male and 28 female patients with their age of 15-69 (44.9±11.9) years and disease duration of 57.8±98.3 months (range, 1 month to 40 years). There were 92 patients with rheumatic VHD, 28 patients with degenerative VHD, 15 patients with congenital VHD, and 9 patients with infective endocarditis. A total of 137 patients who were discharged alive were followed up. Risk factors of postoperative mortality, morbidity and late death of VHD patients with giant left ventricle undergoing HVR were analyzed with t-test, chi-square test or Fisher's exact test, and logistic regression analysis. The life-table method was used to calculate long-term survival rate and draw the survival curve. ResultsMajor postoperative complications included low cardiac output syndrome (LCOS) in 19 patients (13.2%), ventricular arrhythmias in 56 patients (38.9%), prosthetic paravalvular leaks in 7 patients (4.9%), pleural effusion in 33 patients (22.9%), pericardial effusion in 8 patients (5.6%), liver failure in 23 patients (16.0%), and renal failure in 5 patients (3.5%). Seven patients (4.9%) died postoperatively. Logistic univariate analysis showed that advanced-age ( > 50 years), rheumatic VHD, higher preoperative NYHA class (Ⅲ or Ⅳ), long disease duration, poor preoperative left ventricular function[left ventricular ejection fraction (LVEF) < 40%], double valve replace-ment (DVR), other concomitant intracardiac procedures, prolonged cardiopulmonary bypass (CPB) time and aortic cross-clamping time, postoperative LCOS and ventricular arrhythmias were risk factors of early mortality of VHD patients with giant left ventricle undergoing HVR (P < 0.05). Logistic multivariate analysis showed that advanced age ( > 50 years), long disease duration, higher preoperative NYHA class (Ⅳ), poor preoperative left ventricular function (LVEF < 40%), DVR, prolonged CPB time were independent predictors of early mortality (P < 0.05). Logistic multivariate analysis showed that higher preoperative NYHA class (Ⅲ or Ⅳ), other concomitant intracardiac procedures, poor preoperative left ventricular function (LVEF < 50%) were independent predictors of postoperative LCOS (P < 0.05). Higher preoperative NYHA class (Ⅲ or Ⅳ) and preoperative non-sinus rhythm were independent predictors of postoperative ventricular arrhy-thmias (P < 0.05). Within 2 weeks after the operation, left ventricular end-diastolic dimension (LVEDD), left atrial diameter (LAD), LVEF and left ventricular fractional shortening (LVFS) were all significantly reduced compared with preoperative parameters (P < 0.05). Five patients died during follow-up. One-year, 2-year, 3-year and 4-year survival rates were 97.1%, 95.0%, 92.7% and 92.7% respectively. Preoperative LVEF, LVEDD and NYHA were significantly different between patients who died or survived during follow-up. ConclusionsHVR can produce low postoperative mortality, high long-term survival rates and satisfactory clinical outcomes for VHD patients with giant left ventricle. Advanced age ( > 50 years), long disease duration, higher preoperative NYHA class (Ⅳ), preoperative non-sinus rhythm, poor preoperative left ventricular function (LVEF < 40%), DVR and prolonged operation time may be risk factors of postoperative mortality and morbidity. Poor preoperative left ventricular function and significantly enlarged left ventricle may be risk factors of late death after HVR.
ObjectiveTo evaluate the changes of left ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle after mitral valve replacement. MethodsStudies 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. ResultsEight 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. ConclusionLeft ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle recovers well after mitral valve replacement.
ObjectiveTo summarize the indication and surgical experiences of valve replacement, high-risk factors and long-term results for aortic regurgitation and large left ventricle. MethodsWe retrospectively analyzed the clinical data of 42 patients with aortic regurgitation and left ventricle end-diastolic diameter (LVEDD) ≥70 mm and left ventricle end-systolic diameter (LVESD) ≥ 50 mm in our hospital from March 2004 through December 2012. There were 38 males and 4 females,aged 16-73 (45.86±14.99) years. The patients underwent aortic valve replacement, who were evaluated by echocardiography at pre-operation, pre-discharge and early follow-up. The follow up period was 12-132 months. ResultsEarly death occurred in one patient. And five patients died during the follow-up. One week after surgery in 41 patients, LVEDD (62.00±13.21 mm), LVESD (50.71±14.02 mm), indexed LVEDD (35.23±8.58 mm/m2), indexed LVESD (28.92±9.08 mm/m2), LVEF (46.41%±12.49%), were significantly smaller than those before the operation (P<0.01). Heart function grades, preoperative EF, LVEDD and indexed LVEDD were the predictors for left ventricular function recovery. One-year, 5-year, 10-year survival rate was 92.9%, 90.2%, 83.8%, respectively. ConclusionMost of patients with aortic regurgitation and large left ventricle still have indications for surgical treatment, but severe left ventricular dysfunction and ventricular arrhythmia are high risk factors for long-term survival.
The use of echocardiography ventricle segmentation can obtain ventricular volume parameters, and it is helpful to evaluate cardiac function. However, the ultrasound images have the characteristics of high noise and difficulty in segmentation, bringing huge workload to segment the object region manually. Meanwhile, the automatic segmentation technology cannot guarantee the segmentation accuracy. In order to solve this problem, a novel algorithm framework is proposed to segment the ventricle. Firstly, faster region-based convolutional neural network is used to locate the object to get the region of interest. Secondly, K-means is used to pre-segment the image; then a mean shift with adaptive bandwidth of kernel function is proposed to segment the region of interest. Finally, the region growing algorithm is used to get the object region. By this framework, ventricle is obtained automatically without manual localization. Experiments prove that this framework can segment the object accurately, and the algorithm of adaptive mean shift is more stable and accurate than the mean shift with fixed bandwidth on quantitative evaluation. These results show that the method in this paper is helpful for automatic segmentation of left ventricle in echocardiography.
Objective To compare the clinical effect of three operations for one-stage radical correction of small left ventricle in children with tetralogy of Fallot (TOF). Methods We retrospectively analyzed the clinical data of 120 patients with left ventricular dysplasia and TOF undergoing one-stage radical surgery in the First Hospital of Hebei Medical University from December 2004 to May 2017. According to the different types of operation used, they were divided into 3 groups, including a routine group (30 patients, 16 males and 14 females, aged 11.58±2.05 months ranging from 3-24 months), a large patch group (40 patients, 22 males, 18 females, aged 11.22±2.24 months ranging from 3-25 months) who were treated with a large patch, and an enlarged ventricular septal defect group (50 patients, 26 males, 24 females, aged 10.17±2.15 months ranging from 3-22 months) using new left ventricular enlargement technique to enlarge ventricular septal defect. The clinical effect of the three operations were compared. Results The incidence of postoperative low cardiac output syndrome (6.0% vs. 40.0%vs. 50.0%, P<0.05), renal failure (4.0%vs. 37.5% vs.46.7%, P<0.05), infection rate (10.0%vs. 50.0% vs.66.7%, P<0.05), mortality (2.0%vs. 12.5% vs. 20.0%, P<0.05), ventilator-assisted time (8.34±5.24 hvs. 36.14±10.91 h vs. 38.58±10.12 h, P<0.05), ICU stay (4.13±1.01 dvs. 7.64±2.11 d vs.8.03±3.03 d, P<0.05), hospital stay (10.48±4.26 dvs. 21.02±3.23 d vs. 22.52±2.93 d, P<0.05) and hospitalization costs (51 300±9 400 yuanvs.103 200±39 300 yuan vs. 115 500±35 200 yuan, P<0.05) were less in the enlarged ventricular septal defect group compared with the other two groups. Conclusion The clinical effect of enlarged ventricular septal defect is better than that of the routine and large patch methods, and long-term efficacy should be further followed up.