| Objective: Pulmonary hypertension in medicine is divided into primary pulmonary hypertension and secondary pulmonary hypertension, Congenital heart disease and valvular lesions are the two common causes of secondary pulmonary hypertension. Accoding to the level of pulmonary artery pressure, pulmonary hypertension can be classified.Due to the pulmonary vascular severe irreversible change, pulmonary hypertension in medicine is seen as a critical illness.Generally considered that severe pulmonary hypertension in patients with surgical treatment is not very ideal, Even become relative operation contraindications. This topic research valvular disease secondary to severe pulmonary hypertension patients of surgical treatment of early metaphase effect and perioperative treatment. To explore different curative effect of mitral valve lesions secondary surgical treatment of severe pulmonary hypertension in patients. Study the early postoperative effects of risk factors analysis,which impact cardiac recovery.Summary analysis of heart valve disease secondary to severe pulmonary hypertension patients with valvular surgery perioperative treatment experience, and to explore the methods to improve the early survival.Methods: Selected from January 2011 to June 2014 in the First Affiliated Hospital of Anhui Medical University cardiac surgery, 68 patients with severe pulmonary hypertension were done operations, among them,23 patients were males, and 45 patients were females, the study of patients with pulmonary artery systolic pressure greater than 70 mm Hg, the highest pressure was 112 mm Hg, the average pressure was(82.57 + 11.23) mm Hg. Patients aged from 24 to 68 years, the average age were(50.9 ± 10.2) years, The duration of patients were from 12 to 24 years, mean(13.2 ± 5.7) years. 68 cases of patients with severe pulmonary hypertension done valve replacement surgery, by echocardiographic evaluation of therapeutic effect, and the risk factors for postoperative recovery were analysis through the Logistic Regression.Results :Operation processes are smooth, the 66 patients were cured,and other 2 cases were died, echocardiography prompt review of the left arterial diameter(5.10±1.06) cm, left ventricular end-diastolic diameter(4.88 ±0.63) cm, left ventricular ejection fraction(61±5) %, the pulmonary artery pressure was reduced significantly which compared with the preoperative, the pulmonary artery pressure reduced from(82.57±11.23) mm Hg to(40.00±8.88) mm Hg, and several indexes were obviously improved compared with preoperative echocardiography, the differences were statistically significant(P < 0.05). Single factor analysis results indicate that: the age > 65 years(P=0.07), preoperative LA>7.0 cm(P=0.011), LVD>6.5cm(P=0.018), EF<0.5(P=0.032) were risk factors for early bad recovery, and Logistic regression analysis suggest that for patients of severe pulmonary hypertension,age>65 years old, preoperative LVD>6.5cm, EF<0.5 were independent risk factors,which lead to early postoperative death and severe complications.Conclusion:1. Severe pulmonary hypertension patients by valve replacement significantly reduce pulmonary artery systolic pressure, Improve ventricular ejection fraction and heart function. As long as the active preoperative preparation, Perioperative cardio vascular protection and active control of pulmonary hypertension, and severe pulmonary hypertension should not be used as surgical contraindications, take surgical treatment can obtain satisfactory early effect.2. To patients with mitral insufficiency, postoperative early LVEF was declined,which Compared with patients of mitral stenosis, so the patients with mitral insufficiency need greater attention in treatment.3. Age> 65 years, pulmonary hypertension> 80 mm Hg, preoperative LA> 7.0cm, EF <0.5 are independent risk factors for valvular heart disease with severe pulmonary hypertension,which impact postoperative long-term recovery. |
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