[Limitations and extension of surgical indications for acquired valvular heart disease; retrospective study of hospital death].
Between 1981 and 1987, valvular surgery was performed in 988 patients, 27 of which were dead before discharge. Among them, 14 patients of cardiac deaths due to low cardiac output syndrome (LOS) and arrhythmias were analyzed to withdraw factors correlated with their cause of death. There was a tendency for the patients with stenotic valvular disease to die of LOS and regurgitant valvular lesions of arrhythmias. Statistical analysis showed the cause of deaths were multifarious including pulmonary, hepatic and renal failure, so no definite factor was pointed out. Case study of typical limited and extended surgical indications revealed (1) the patients with mitral stenosis combined with organic tricuspid regurgitation and RV/LV EDVI ratio over 1.5, and (2) the patients with aortic insufficiency and LVEDVI over 400 ml/m2 or LVESVI over 300 ml/m2 were candidate for hospital death after valve replacement. Extended approach for those patients should be two staged heart transplantation using ventricular assist device.
Seno
R
R
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Imamura
E
E
Endo
M
M
Hashimoto
A
A
Koyanagi
H
H
D000328:Adult; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies