Assessment of clinical, paraclinical and surgical characteristics of patients received mitral valve replacement with St.Jude valves at 108 military central hospital

Objectives: To review some clinical, paraclinical and surgical characteristics of patients received mitral valve replacement with St.Jude mechanical valve (SJM) at 108 Military Central Hospital. Subjects and methods: 122 patients received mitral valve replacement with SJM. Clinical and paraclinical criteria based on the criteria of the Vietnam National Heart Association and ACC/AHA guidelines.

ASSESSMENT OF CLINICAL, PARACLINICAL AND SURGICAL

CHARACTERISTICS OF PATIENTS RECEIVED MITRAL VALVE

REPLACEMENT WITH ST.JUDE VALVES AT

108 MILITARY CENTRAL HOSPITAL

Do Xuan Hai*; Hoang Quoc Toan**; Mai Van Vien**

Nguyen Van Nam***; Nguyen Truong Giang*

SUMMARY

Objectives: To review some clinical, paraclinical and surgical characteristics of patients

received mitral valve replacement with St.Jude mechanical valve (SJM) at 108 Military Central

Hospital Subjects and methods: 122 patients received mitral valve replacement with SJM

Clinical and paraclinical criteria based on the criteria of the Vietnam National Heart Association

and ACC/AHA guidelines Results: Anamnesis of rheumatic fever was 68.9%, NYHA II and III

were 100%, thickening sticky and calcification of mitral valve and ligament injury were over

74% Sinus rhythm and thrombosis were about 30% The valve size 29 and 31 were mostly

used (97.5%) The mean aortic cross-clamp time and operative time were 60.3 ± 26.5 minutes

and 123.5 ± 33.5 minutes Conclusion: The main clinical features of mitral valve disease include

exertional dyspnea, chest pain, atrial fibrillation The causes of valve injury were due to

rheumatic fever mainly thickening sticky, calcification and shrinkage ligament The 29 size SJM

was the most used valves which accouned for more than 50% of all valve replacement cases

* Keywords: Mitral valve; Mitral valve replacement; Saint Jude mechanical valve; Characteristics

INTRODUCTION

Mitral valve is located between two left

chambers of heart and keeping blood

flowing properly in one direction from the

left atrium to the left ventricle [6]

According to the studies, mitral valve

disease accounts for 40% of heart valve

disease cases and if left untreated,

severe cases can lead to heart failure or

irregular heartbeats, called arrhythmias,

which may be life-threatening [4, 5] Mitral

valve replacement with a mechanical

valve are still very effective The SJM

prosthesis was the first bileaflet

mechanical prosthesis implanted in 1978

in Europe Within a few years, this prosthesis became the gold standard for mitral valve replacement Its low-profile design and high biocompatibility explain its excellent hemodynamic performance

To date, many studies have been conducted on the valve of SJM, but the structure varies according to the mission

of each hospital, the structure and characteristics of mitral valve disease vary with time, natural conditions and socio-cultural level Therefore, the aim of

this study is to: Review some clinical, paraclinical and surgical characteristics of patients received mitral valve replacement with SJM at 108 Military Central Hospital

* Vietnam Military Medical University

** 108 Military Central Hospital

*** 103 Military Hospital

Corresponding author: Do Xuan Hai (bsdoxuanhai@yahoo.com.vn)

Date received: 30/08/2017

Date accepted: 26/09/2017

SUBJECTS AND METHODS

1 Subjects

174 patients were diagnosed as mitral

valve disease and received mitral valve

replacement with SJM valves at 108 Military

Central Hospital during the period from

05 - 2010 to 12 - 2014

2 Methods

- Research method: Prospective research,

descriptive cross-sectional study

- Research procedure: Study the history

of the disease, clinical and paraclinical

characteristics and surgery, under a uniform

procedure definition

- Evaluative criteria based on the

standards of the Vietnam National Heart

Association and ACC/AHA guidelines (USA)

* Statistical analysis:

Data were analyzed by SPSS

programe 16.0 Value are presented as

mean values, SD, percentage rate and p

values of under 0.05 were considered to

be significant

RESULTS AND DISCUSSION

1 Clinical characteristics

Table 1: Some clinical and historical

characteristics (n = 122)

Clinical characteristics,

medical history

Rate (%)

Anamnesis of

rheumatic fever

Anamnesis of

mitral valve

intervention

mitral valvotomy

16.4

Anamnesis of rheumatic fever accounted for high rates of 68.9%, 16.4% of patients underwent percutaneous balloon mitral valvotomy This result was consistent with the domestic announcement that rheumatic fever was the main cause of mitral valve disease in developing countries [3, 4]

by different from the study in developed countries, it was to degeneration of heart [6] However, there were 20.5% of rheumatic fever without treatment, it proved that knowledge of disease and its complications was limited The NYHA class II and III were 100%, in which the NYHA II was the majority Severe heart failure in this study was lower in than other domestic studies (49,5 - 62,3%) but similar to Bui Duc Phu’s results (41,9%) and much lower than in other studies in the world (60 - 90%) [8] Because It was the first stage of open heart surgery at 108 Military Central Hospital, intensive care unit (ICU) of heart located on the same place with ICU of general hospital Therefore, it would be very difficult to care patients with NYHA IV with many complications after surgery The main symptoms included shortness

of breath on exertion, palpitations (> 92%) and arrhythmia (65.6%), that were similar

to many other studies The cause might

be due to patients’ anxiety of surgery and family’s financial economy [2]

2 Some paraclinical characteristics

of mitral valve disease

Table 2: Some major paraclinical

characteristics (n = 122)

Paraclinical features Rate

(%)

Electrocardiogram

Echocardiography

Very severe mitral stenosis

0.0

Severe mitral valve regurgitation

9.0

Severe systolic pulmonary artery hypertension

13.1

Thickening and sticky of mitral valve

95.9

Calcification of mitral valve

74.6

The ligaments of the mitral valve are shrinking

81.1

Wilkins echocardiographic

65.6% of patients had atrial fibrillation,

some domestic reports had also this ratio

(50 - 80%) [2] and it was higher than

many studies in the world [5, 7] It may be

due to elderly patients, changes in the

size of the heart chambers [7] Typical

mitral valve injury due to rheumatic fever

in echocardiography included thickening

and sticky, calcification of mitral valve

and ligaments injury (> 74%), Wilkins

≥ 8 points was 100% Sinus rhythm and

thrombosis were about 30% These

results were higher than those by some

other authors and similar to Bui Duc

Phu’s results [2, 3] Those differences

might be due to patient selection and

treatment

3 Some characteristics in the operation

* The size of SJM valves (n = 122):

Size 27: 3 cases (2.5%); size 29: 63 cases (51.6%); size 31: 56 cases (45.9%)

Choosing the valve size depended on the mitral valve annuloplasty and body surface area The results showed that the most used valves were 29 and 31, accounted for 97.5%, of which valve size 29 accounted for more than 50% of mitral valves replacement cases Many other studies have also showed that valve sizes 29 and 31 were very suitable for Vietnamese adults (EOA: 2.03 ± 0.32 cm², average pressure difference across the valve: 6.6 ± 2.3 mmHg) and it was the most extended angle valve (85°) [8]

Table 3: Aortic cross-clamp, CPB and

operative time (n = 122)

Time (minute) Minimum Maximum Mean

Aortic

cross-clamp time

Operative

time

Operative time was about 120 minutes Mean aortic cross-clamp time was 60.3 ± 26.5 minutes and mean CPB time was 95.6 ± 32.1 minutes Many authors were interested in aortic cross-clamp times, CPB time and operative time because the longer times it was, the more postoperative complications happened Those times in our study were shorter than that in research by Nguyen Huu Uoc and many other foreign authors, possibly owing to more complex disease with multiple composite lesions

CONCLUSION

The main clinical characteristics of

mitral valve disease include exertional

dyspnea, chest pain, atrial fibrillation

Valve injury is due to rheumatic fever

mainly thickening, calcification and the

shrinking of ligaments The 29 size SJM is

the most used valves, accounted for more

than 50% of valve replacement cases

REFFERENCES

1 Đo n u c Hưng, h m u c Đ t,

Nguyễn H u c Kết quả s a van ba lá

trong điều trị bệnh van tim m c phải tại ệnh

viện H u nghị iệt ức Tạp ch Tim mạch

học iệt Nam 2013, 64, tr.1-10

2 Nguyễn Đức Hiền, Bùi Đức Phú ánh

giá kết quả phẫu thuật thay van hai lá cơ học

ở bệnh nhân hẹp van hai lá Hội nghị Phẫu

thuật Tim mạch và L ng ng c iệt Nam

2011, tr.1233-1239

3 Nguyễn Văn han Nh ng yếu tố liên

quan đến chỉ định can thiệp bệnh hở van ba

lá đ ng thời trong phẫu thuật van hai lá tại Viện Tim TP H Chí Minh Tạp chí Phẫu thuật Tim mạch và L ng ng c 2014, 4, tr.3-8

4 Ph m Nguyễn Vinh Bệnh học tim mạch

Nhà xuất bản Y học, TP H Chí Minh 2003, tr.205- 255

5 Carpentier A, Adams D.H, Filsoufi F

Reconstructive Valve Surgery Sauders Elsevier, French 2010

6 Lawrence H Cohn Cardiac Surgery in

the Adult McGraw - Hill Global Education, New York, USA 2008

7 Katlic M.R Cardiothoracic Surgery in

the Elderly Springer Science + Business Media, New York, USA 2011

8 Kouchoukos N.T, Blackstone E.H, Doty D.B et al Cardiac Surgery Churchill Livingstone,

Saltlake, USA 2010

9 World Health Organization Rheumatic

WHO Expert Consultation Geneva 2004, pp.1-122