Efficacy Of Mitral Valvuloplasty In The Treatment Of Degenerative Mitral Insufficiency

BackgroundHeart valve disease is a common disease in the field of cardiac surgery.Its causes are complex and diverse.Due to the improvement of people’s living standards and the aging of the population,heart valve disease caused by degenerative diseases is increasing.Degenerated cardiac valvular disease(DCVD)is considered to be one of the important causes of heart failure,arrhythmia and sudden death in the elderly.Degenerative heart valve disease most often involves the mitral valve,which manifests as prolapse of the mitral valve annulus and rupture of the tendon cord,resulting in incomplete closure of the mitral valve.The surgical methods for treating degenerative mitral insufficiency in cardiac surgery include mitral valvuloplasty and mitral valve replacement.According to the actual situation of the patient,choose the most suitable surgical method to benefit the patient and improve the patient’s quality of life.It is necessary to compare the clinical efficacy of different surgical methods to provide a theoretical basis for clinical selection of surgical methods.Part I ObjectiveTo investigate the efficacy of mitral valvuloplasty in the treatment of degenerative mitral insufficiency.Materials and MethodsA retrospective analysis of the clinical data of 148 patients who underwent mitral valvuloplasty in our center from May 2010 to May 2019 due to degenerative mitral regurgitation.Screened and excluded based on clinical diagnosis,intraoperative findings and postoperative pathology,a total of 106 patients were included,including 65 males(61.32%)and 41 females(38.68%),aged 40 to 85(58.26 ± 11.28).According to preoperative cardiac color doppler ultrasound examination,23(21.70%)cases had moderate mitral regurgitation and 83(78.30%)cases had severe regurgitation.According to the New York Heart Association(NYHA)cardiac function grading before operation,there were 27(25.47%)cases of grade II,71(66.98%)cases of grade III,and 8(7.56%)cases of grade IV.During the operation,the cardiac injection test and transesophageal echocardiography(TEE)were used to evaluate the effect of forming.ResultsFollow-up was performed by telephone and outpatient.The follow-up period ranged from 1 to 132(68.60 ± 38.52)months.89 cases were followed up with a follow-up rate of 85.58%.The time for postoperative cardiac echocardiography review is 1 to 6(3 ± 2)months after surgery.1.There were 67(63.21%)cases of mitral valve without or little reflux after operation,39(36.79%)cases of mild reflux,and no cases of moderate to severe reflux.Among the patients who were followed up in the postoperative period,54(68.35%)patients had NYHA cardiac function grade I,20(25.32%)patients had grade II,and 5(6.33%)patients had grade III.2.Comparison of cardiac color Doppler ultrasound examination before and after surgery,left atrial diameter(LAD)[(3.87 ± 0.70)cm and(4.54 ± 0.78)cm],left ventricular end-diastolic diameter,LVEDD)[(4.75 ± 0.55)cm and(5.40 ±0.71)cm] was significantly reduced compared with preoperative,the difference was statistically significant(P <0.05).The left ventricular ejection fraction(LVEF)was significantly higher than before surgery [(59.36 ± 6.54)% and(56.04 ±6.45)%].Part II ObjectiveTo compare the efficacy of mitral valvuloplasty and mitral valve replacement in the treatment of degenerative mitral regurgitation.Materials and MethodsA retrospective analysis of patients who had undergone mitral valve surgery in our center from May 2017 to May 2019 due to degenerative mitral regurgitation was screened based on clinical diagnosis,intraoperative findings and postoperative pathology.Finally,60 patients were included,including 34 males and 26 females,aged 40 to 72 years,with an average of(53.20 ± 8.74)years old.The patients were divided into two groups according to different surgical methods,repair group(n =30)and replacement group(n = 30).According to preoperative cardiac color doppler ultrasound examination,15(50.00%)cases of moderate mitral regurgitation in the repair group and 15(50.00%)cases of severe regurgitation;In the replacement group,13 cases(43.33%)had moderate reflux and 17 cases(56.67%)had severe reflux.Preoperative NYHA cardiac function classification,8(26.67%)cases in grade II,20(66.67%)cases in grade III,2(6.67%)cases in grade IV.In the replacement group,there were 8(26.67%)cases with NYHA cardiac function grade II,18(60.00%)cases with grade III,and 4(13.33)cases with grade IV.During the operation,the effect of surgery was evaluated by cardiac injection test and transesophageal echocardiography.ResultsThere were no deaths during the perioperative period.Follow-up was performed by telephone and outpatient.The follow-up was 1 to 6(3.97 ± 1.54)months.60 cases were followed up with a follow-up rate of 100.00%.The time for postoperative cardiac echocardiography review is 1 to 6(3 ± 2)months after surgery.1.In the repair group,there were 12(40.00%)cases of mitral regurgitation after operation,18(60.00%)cases of mild regurgitation,and no cases of moderate to severe regurgitation.In the replacement group,there were 16(53.33%)cases of mitral regurgitation after operation,14(46.67%)cases of mild regurgitation,and no cases of moderate to severe regurgitation.Postoperative cardiac function classification in the repair group,grade I 16(53.33%)cases,grade II 12(40.00%)cases,grade III 2(6.67%)cases.In replacement group postoperative cardiac function grade I 15(50.00%)Cases,grade II 12(40.00%)cases,grade III 3(10.00%)cases.2.Change of left atrium diameter index(LADI)[(-16.80 ± 10.35)% and(-10.17 ± 16.22)%] and improvement of LVEF in the repair group were better than those in the replacement group.In addition,the volume of blood transfusion 24 hours after surgery,the number of hospital days after surgery,and the incidence of postoperative complications were significantly lower in the repair group than in the replacement group,with a statistically significant difference(P <0.05).Conclusions1.Mitral valvuloplasty is effective in treating degenerative mitral regurgitation.2.Mitral valvuloplasty is superior to mitral valve replacement in the short-term treatment of degenerative mitral regurgitation.3.Mitral valvuloplasty is the first choice for the treatment of degenerative mitral regurgitation.It can effectively correct mitral valve regurgitation,promote the recovery of cardiac function and reverse remodeling of the left atrium.The postoperative complication rate is low.Mitral valvuloplasty has definite curative effect and is worthy of promotion...