Effect of physiological overload on pregnancy in women with mitral regurgitation

OBJECTIVES:

to evaluate the structural and functional heart abnormalities in women with mitral regurgitation during pregnancy.

INTRODUCTION:

Women with mitral regurgitation progress well during pregnancy. However, the effects on the heart of the association between pregnancy and mitral regurgitation are not well established.

METHODS:

This is a case–control, longitudinal prospective study. Echocardiograms were performed in 18 women with mitral regurgitation at the 12th and 36th week of pregnancy and on the 45th day of the puerperium. Twelve age‐matched healthy and pregnant women were included as controls and underwent the same evaluation as the study group.

RESULTS:

Compared with controls, women with mitral regurgitation presented increased left cardiac chambers in all evaluations. Increasing left atrium during pregnancy occurred only in the mitral regurgitation group. At the end of the puerperium, women with mitral regurgitation showed persistent enlargement of the left atrium compared with the beginning of pregnancy (5.0 ± 1.1 cm vs 4.6 ± 0.9 cm; p<0.05). Reduced left ventricular relative wall thickness (0.13 ± 0.02 vs 0.16 ± 0.02; p<0.05) and an increased peak of afterload (278 ± 55 g/cm² vs 207 ± 28 g/cm²; p<0.05) was still observed on the 45th day after delivery in the mitral regurgitation group compared with controls.

CONCLUSIONS:

Pregnancy causes unfavorable structural alterations in women with mitral regurgitation that are associated with an aggravation of the hemodynamic overload.     

冠心病合并心脏瓣膜疾病同期手术治疗的围手术期处理要点

目的：探讨同期行冠脉旁路移植术和瓣膜置换或瓣膜成形术的围手术期的处理要点和注意事项,以期降低该类手术围手术期的死亡率。方法：通过Pubmed、万方数据库、中国知网等检索近几年国内外关于同期行冠脉旁路移植术和瓣膜置换或瓣膜成形术研究的相关文献,总结其围手术期的处理要点和注意事项。结果：同期行冠脉旁路移植术和瓣膜置换或瓣膜成形术,术前应注意患者各脏器功能情况,积极处理合并症;严格掌握手术适应证,制定合理的手术方式、手术流程;术中需掌握各种手术技巧,注意加强心肌保护;术后积极处理各种并发症。结论：同期行冠脉旁路移植术和瓣膜置换或瓣膜成形术,重视并掌握围手术期的处理要点和注意事项,在提高该类手术病人的生存率上起关键作用,能有效提高病人术后生存质量、降低其死亡率。     

Heart rate variability in soccer players with mitral valve prolapse or benign arrhythmia

Abstract Numerous studies have reported increased cardiac vagal activity in well endurance-trained athletes. However, no clear data exist regarding the cardiac autonomic activity in athletes with common cardiovascular findings, such as mild mitral valve prolapse (MVP) and transient benign arrhythmias. Therefore, the purpose of this study was to investigate and compare the cardiac autonomic outflow by heart rate variability (HRV) analysis between soccer players with mild MVP and rhythm disorders and other athletes with transient benign arrhythmias but without any structural cardiac disease. Twenty Greek male soccer players with mild MVP (group A, aged 20.2±4.5 years), 20 players with benign cardiac rhythm and conduction disorders without structural cardiac disease (group B, aged 21.0±3.6 years) and 20 healthy age-matched sedentary men (group C) were examined. All subjects underwent clinical evaluation, resting electrocardiogram for QTc calculation, echocardiography and 24-h ambulatory Holter recordings for HRV analysis. The mean 24-h heart rate, the HRV index and the mean 24-h R-R interval were significantly increased in all athletes compared to controls (p<0.05). Moreover, group A presented significantly decreased HRV index compared to group B by 18.2% (p<0.05). Resting QTc was prolonged only in group B compared to groups A and C by 9.5% and 11.2%, respectively (p<0.05), whereas no significant difference was found between groups A and C. It is concluded that athletes with MVP present limited exercise-induced cardiac vagal predominance compared to those with benign arrhythmias and without any structural cardiac disease.     

Long-term outcomes of rigid ring versus De Vega annuloplasty for functional tricuspid regurgitation: A propensity score-matching analysis

ObjectiveThis study was conducted to compare the outcomes of rigid ring versus De Vega annuloplasty for the treatment of functional tricuspid regurgitation (TR).MethodsFrom 2003 to 2017, De Vega annuloplasty (group D) was used in 231 patients, and rigid ring annuloplasty (group R) was used in 204 patients for the treatment of functional TR during left-sided valve surgery. A propensity score-matching analysis was used to pair group D (n = 109) with group R (n = 109). The primary outcomes were long-term overall survival and cardiac death, and the secondary outcomes were tricuspid valve-related events and TR recurrence (TR moderate or severe). The follow-up data were complete in 99.6% (447 out of 449) of the patients with a follow-up duration of 102 months.ResultsThere were no differences in the overall survival and cardiac death between the propensity score-matched groups (P = .793 and P = .175, respectively) up to 14 years after surgery. Tricuspid valve-related events, including cardiac death, permanent pacemaker implantation, thromboembolism, bleeding and tricuspid valve reoperation were also similar between the 2 matched groups during the follow-up (P > .999). However, cumulative incidence of TR recurrence was significantly higher in group R than in group D (P = .007). Multivariate analysis indicated the annuloplasty method (De Vega) and preoperative TR grade as risk factors for late TR recurrence.ConclusionsIn functional TR, annuloplasty methods did not influence long-term overall survival, cardiac mortality, and tricuspid valve-related events. However, rigid ring annuloplasty showed less late TR recurrence. Rigid ring annuloplasty can be considered for the treatment of functional TR in terms of its better durability.     

双孔成形术治疗二尖瓣前叶脱垂

目的　进一步探讨双孔成形技术治疗二尖瓣前叶脱垂的临床可行性。方法　对 35例二尖瓣前叶脱垂的病人行双孔成形手术 ,并在术前、术中、术后利用超声心动图对瓣膜进行评价。并与同期行二尖瓣置换者进行比较。结果　全组术前平均瓣口面积 ( 8 3± 1 6 )cm2 ,术后瓣口面积为 ( 4 1±1 8)cm2 。术后 33例病人无瓣膜反流 ,2例二尖瓣轻度反流。全组无术后死亡。随访 1～ 40个月 ,所有病人心功能 (NYHA)为I级 ;超声心动图显示双孔成形瓣膜活动良好 ,无瓣口狭窄。结论　双孔瓣膜成形技术治疗二尖瓣前叶脱垂 ,疗效稳定 ,死亡率低 ,无并发症 ,早期、中期疗效满意。     

Predicting the outcome of transcatheter mitral valve implantation using image-based computational models

BackgroundThe appropriate placement and size selection of mitral prostheses in transcatheter mitral valve implantation (TMVI) is critical, as encroachment on the left ventricular outflow tract (LVOT) may lead to flow obstruction. Recent advances in computed tomography (CT) can be employed for pre-procedural planning of mitral prosthetic valve placement. This study aims to develop patient-specific computational fluid dynamics models of the left ventricle (LV) in the presence of a mitral valve prosthesis to investigate blood flow and LVOT pressure gradient during systole.MethodsPatient-specific computational fluid dynamics simulations of TMVI with varied cardiac anatomy and insertion angles were performed (n = 30). Wide-volume full cycle cardiovascular CT images prior to TMVI were used as source anatomical data (n = 6 patients). Blood movement was governed by Navier-Stokes equations and the LV endocardial wall deformation was derived from each patient's CT images.ResultsThe computed pressure gradients in the presence of the mitral prosthesis compared well with clinically measured gradients. Analysis of the effects of prosthetic valve angulation, aorto-mitral annular angle, ejection fraction, LV size and new LVOT area (neo-LVOT) after TMVI in silico revealed that the neo-LVOT area (p < 0.001) was the most significant factor affecting LVOT pressure gradient. Angulation of the mitral valve can substantially mitigate LVOT gradient.ConclusionsComputational fluid dynamics simulation is a promising method to aid in pre-TMVI planning and understanding the factors underlying LVOT obstruction.     

"缘对缘"术治疗Barlow病引发的二尖瓣关闭不全

目的探讨"缘对缘"(edge-to-edge)技术治疗Barlow病(Barlow's disease)引起的二尖瓣关闭不全的有效性及安全性.方法2000年4月至2005年4月采用"缘对缘"术式治疗14例Barlow病病人,观察术前术后二尖瓣反流量、术后瓣口面积、左室流出道流速、跨瓣压差及心功能状态等相关指标变化.结果无围术期死亡.术中、术后1周心脏超声检查显示9例二尖瓣微量反流,5例轻度反流.术前6例左室流出道流速(116.33±5.05)cm/s,术后1周(107.17±10.23)cm/s(P＞0.05).14例随访1～60个月,平均26.8个月;无死亡及二次手术.术后二尖瓣瓣口平均面积为(3.00±0.57)cm2;跨瓣压差术前(8.13±4.49)mmHg(1 mmHg=0.133 kPa),术后(6.25±3.82)mmHg(P=0.050).8例二尖瓣微量反流,6例轻度反流.术后心功能均恢复至Ⅰ～Ⅱ级.结论"缘对缘"术是治疗Barlow病导致二尖瓣关闭不全的一种简单易行且安全有效的手术方式,但远期疗效尚需进一步观察.