title: [Clinical analyses of cardiovascular operations in patients with severe dilated left ventricle].
abstract: OBJECTIVE
  To explore the perioperative features of surgical treatment in valvular patients with severe dilated left ventricle and investigate the structural changes of left ventricle and its correlation with cardiac functions.
  
  
  METHODS
  A total of 126 patients with severe dilated left ventricle underwent mitral valve and/or aortic valve operation from January 2003 to December 2008, including mitral valve replacement (MVR) (n = 27), mitral valvuloplasty (MVP) (n = 13), aortic valve replacement (AVR) (n = 51), AVR+MVR (n = 25) and AVR + MVP (n = 10). There were 79 males and 47 females with a mean age of (52 ± 13) years old. The mean pathological course was (18 ± 12) years. The pathological changes were mainly of aortic and/or mitral incompetence. The concomitant procedures included Bentall procedure (n = 6), coronary artery bypass grafting (n = 3), tricuspid valvuloplasty (n = 58) and left atrial folding (n = 62).
  
  
  RESULTS
  The perioperative mortality was 3.17% (4/126). Two died of multiple organ failure (MOF) secondarily to severe low-output syndrome while another 2 died of sudden ventricular fibrillation. Forty-six (36.5%) patients suffered from ventricular arrhythmia during the earlier postoperative period and they required a venous injection of lidocaine and/or amiodarone. Fourteen (11.1%) patients suffered from severe low-output syndrome. Among them, 4 patients were resuscitated with an intra-aortic balloon pump for another 4 - 6 days. And 26 (20.6%) cases were complicated with multiple organ failure. The echocardiographic examinations showed that left ventricular dimensions decreased significantly at Days 7 - 14 postoperatively and progressively at Months 6 - 12 postoperatively. Left ventricular end-diastolic diameter (LVEDD) was (77 ± 6) mm preoperatively and (63 ± 12) mm (Days 7 - 14), (58 ± 10) mm (Months 6 - 12) postoperatively (P < 0.01). The contractile function of left ventricle temporarily decreased during the early postoperative stage and improved gradually afterwards. But it was not restored to normal range even until 6 - 12 m post-operation. Ejection fraction was 49% ± 12% preoperatively and 42% ± 9% (Days 7 - 14), 51% ± 7% (Months 6 - 12) postoperatively (P < 0.01). Left ventricular fraction shortness was 28% ± 7% preoperatively and 25% ± 4% (Days 7 - 14), 29% ± 5% (Months 6 - 12) postoperatively (P < 0.05).
  
  
  CONCLUSIONS
  For the patients with severe dilated left ventricle, cardiovascular operation can achieve an excellent outcome through a rigorous perioperative regiment. The prevention and treatment of postoperative ventricular arrhythmia should be emphasized. The dimension of left ventricle decreases progressively during the early postoperative period. There is a postoperative decline of cardiac functions.
authors.affiliation: Department of Cardiaovascular Surgery, Chinese PLA Cardiac Surgery Institute, Beijing 100853, China. jiangsl301@sina.com
authors.forename: Sheng-li
authors.initials: SL
authors.lastname: Jiang
authors.forename: Bo-jun
authors.initials: BJ
authors.lastname: Li
authors.forename: Chang-qing
authors.initials: CQ
authors.lastname: Gao
authors.forename: Chong-lei
authors.initials: CL
authors.lastname: Ren
authors.forename: Yao
authors.initials: Y
authors.lastname: Wang
authors.forename: Ting-ting
authors.initials: TT
authors.lastname: Cheng
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.forename: Tao
authors.initials: T
authors.lastname: Zhao
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005260:Female; D006349:Heart Valve Diseases / Q000473:pathology* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult