Abstract：Objective This study was performed to explore the early and mid-term clinical outcomes of "three-valve" (aortic, mitral, and tricuspid valves) repair surgery in the treatment of rheumatic heart valve disease. Methods This work was a case series report. From January 2018 to June 2022, a total of 38 patients with rheumatic heart disease (10 males and 28 females) in the Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital were examined. The age was 38-69 (53.2±8.8) years. The New York Heart Association classification grade Ⅰ was found in 17 patients, grade Ⅱ was found in eight patients, grade Ⅲ in 10 patients, and grade Ⅳ in three patients. Mitral valve regurgitation was moderate and above for 20 patients. Aortic valve regurgitation was moderate and above for 18 patients. Aortic valve stenosis was moderate and above for 18 patients. Tricuspid valve regurgitation was moderate and above for 19 patients. All the patients were treated with triple valve repair through sternotomy incision. The observation indexes were obtained as follows: (1) intraoperative cardiopulmonary bypass time, aortic cross-clamp time, operative time, and intraoperative transesophageal cardiac ultrasonography were used in assessing the effect of valve repair; (2) drainage volume 24 h after operation, cardiac intensive care unit (CICU) time, low cardiac output syndrome, hypoxemia, severe arrhythmias, pericardial effusion, and presence of secondary open-heart surgery due to postoperative bleeding were used. Transthoracic echocardiography was performed before discharge to observe the regurgitation of aortic, mitral, and tricuspid valves. (3) The patients were followed up regularly after discharge from the hospital, and transthoracic echocardiography was repeated to observe the presence of perivalvular leakage, regurgitation after valve repair, peak mitral diastolic flow velocity, and average mitral transvalvular pressure difference; electrocardiogram was repeated to observe the presence of persistent atrial fibrillation. The occurrence of cardiovascular-related adverse events and the need for secondary surgery because of valve regurgitation were observed during the follow-up period. Results (1) All 38 patients completed triple valve repair. Cardiopulmonary bypass time was 97-205 (138±30) min; aortic cross-clamp time was 76-149 (106±26) min; and operative time was 96-255 (161±55) min. Intraoperative transesophageal cardiac ultrasonography showed preoperative aortic vena contracta (4.2-0.7) mm. Only mild-to-moderate postoperative regurgitation of the aortic valve was observed in two patients, and mild-to-moderate regurgitation of the mitral valve was observed in two patients. The other patients showed no regurgitation or mild regurgitation, no patient presented systolic anterior motion. (2) CICU stay was 2.0 (2.0, 2.5) d, and the drainage was 270 (225, 465) mL 24 h after operation in all 38 patients. The patients recovered well after surgery, with good incisional healing and without complications, such as low cardiac output syndrome, hypoxemia, or severe arrhythmias. In addition, no indications for secondary surgery were observed, and no early postoperative death occurred. Regular follow-up with transthoracic echocardiography before discharge showed no valve showing stenosis, two patients of aortic valve and mitral valve showed mild-to-moderate regurgitation, four patients of tricuspid valve showed mild-to-moderate regurgitation, and the rest of the valves had sub-mild regurgitation. (3) After 3-54 (22.3±4.5)months of follow-up, shortness of breath, palpitations, and dizziness were alleviated to varying degrees in 38 patients, activity endurance increased significantly compared with that before operation, no cardiovascular adverse events occurred, and no patient died. Transthoracic echocardiography at the last follow-up review showed no stenosis of the aortic and mitral valves, three patients of the aortic valve and mitral valve showed mild-to-moderate regurgitation, and the rest of the valves had sub-mild regurgitation. The peak mitral diastolic flow velocity was 0.8-1.9 (1.3±0.3) m/s, and the average mitral transvalvular pressure was 2.6-4.8 (3.1±1.4)mmHg (1 mmHg=0.133 kPa) at the last follow-up. Reexamination of electrocardiogram showed three patients of residual atrial fibrillation in 24 patients who underwent radiofrequency ablation of atrial fibrillation, and the remaining patients did not develop new-onset postoperative arrhythmia. Conclusion For patients with rheumatic heart disease involving three valves, mitral valve with possibility of repair, tricuspid valve with more than mild functional valve regurgitation, aortic valve leaflets with fair quality, and less than moderate stenosis or regurgitation, triple valve repair can be performed, which can improve outcomes and thereby effectively improves patients' early and mid-term valve regurgitation after operation and early and mid-term clinical efficacy.
高雅萱, 庄皓舜, 杨蓉, 罗汉卿, 李捷, 王东进, 曹海龙. 三瓣膜修复治疗风湿性心脏瓣膜病的近中期效果观察[J]. 中华解剖与临床杂志, 2023, 28(11): 709-714.
Gao Yaxuan, Zhuang Haoshun, Yang Rong, Luo Hanqing, Li Jie, Wang Dongjin, Cao Hailong. Observation on the early and mid-term effects of triple valve repair for rheumatic heart valve disease. Chinese Journal of Anatomy and Clinics, 2023, 28(11): 709-714.
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2023, Vol. 28 
