MINISTRY OF EDUCATION AND TRAINING MINISTRY OF NATIONAL DEFENCE VIETNAM MILITARY MEDICAL UNIVERSITY TRAN THANH BINH RESEARCH ON APPLICATION OF TECHNIQUES TO PRESERVE THE SUBVALVULAR APPARATUS IN MITRA[.]
MINISTRY OF EDUCATION AND MINISTRY OF NATIONAL TRAINING DEFENCE VIETNAM MILITARY MEDICAL UNIVERSITY TRAN THANH BINH RESEARCH ON APPLICATION OF TECHNIQUES TO PRESERVE THE SUBVALVULAR APPARATUS IN MITRAL VALVE REPLACEMENT SURGERY MEDICAL DOCTORAL THESIS HANOI – 2022 MINISTRY OF EDUCATION AND MINISTRY OF NATIONAL TRAINING DEFENCE VIETNAM MILITARY MEDICAL UNIVERSITY TRAN THANH BINH RESEARCH ON APPLICATION OF TECHNIQUES TO PRESERVE THE SUBVALVULAR APPARATUS IN MITRAL VALVE REPLACEMENT SURGERY Speciality: Surgery Code: 9720104 MEDICAL DOCTORAL THESIS Supervisors : Prof Bui Duc Phu Assoc.PhD Dang Ngoc Hung HANOI – 2022 DECLARATION I hereby declare that this is my own research work The data and results stated in the thesis are honest and have never been published in any other works Hanoi, date month…2022 Thesis author TABLE OF CONTENTS Declaratio Table of contents List of Abbreviations List of Tables List of Charts List of Diagrams List of Figures INTRODUCTION CHAPTER LITERATURE REVIEW 1.1 MITRAL VALVE ANATOMY 1.1.1 Annulus firosus of mitral valve 1.1.2 Cusps of mitral valve 1.1.3 Subvalvular apparatus of mitral valve 1.1.4 Arterial feeding mitral valve 14 1.1.5 Nerve distribution for mitral valve 15 1.2 MITRAL VALVE DISEASE 16 1.2.1 Mitral valve stenosis 16 1.2.2 Mitral valve regurgitation 20 1.3 Mitral valve replacement surgery 23 1.3.1 History of mitral valve replacement surgery 23 1.3.2 Mechanical prosthetic mitral valve replacement surgery 26 1.3.3 Mechanical mitral valve replacement surgery with preservation of the subvalvular apparatus 31 CHAPTER RESEARCH SUBJECTS AND METHODS 43 2.1 RESEARCH SUBJECTS 43 2.1.1 Inclusion criteria 43 2.1.2 Exclusion criteria 43 2.2 RESEARCH METHODS 44 2.2.1 Research design 44 2.2.2 Study sample size 44 2.2.3 Steps to conduct research 44 2.2.4 Data collection 45 2.2.5 Research targets 45 2.2.6 Research processes 56 2.3 RESEARCH MEDIA 67 2.4 DATA PROCESSING 69 2.5 RESEARCH ETHICS 70 CHAPTER RESEARCH RESULTS 72 3.1 CLINICAL AND PARACLINICAL CHARACTERISTICS 72 3.1.1 General characteristics of the study group 72 3.1.2 Preoperative subclinical characteristics 75 3.2 OPERATIVE CHARACTERISTICS 80 3.2.1 Characteristics of intraoperatively cardiac injuries determination 80 3.2.2 Surgical specification 82 3.2.3 Characteristics of intraoperatively cardiac resuscitation 87 3.3 CHARACTERISTICS OF MONITORING AND TREATMENT IN THE POSTOPERATIVE PERIOD 88 3.4 RESULTS OF POSTOPERATIVE MONITORING AND INSPECTION 94 3.4.1 Characteristics of postoperative heart failure according to NYHA 95 3.4.2 Post-operative subclinical characteristics 97 CHAPTER DISCUSSION 109 4.1 CLINICAL AND SUBCLINICAL CHARACTERISTICS 109 4.1.1 General characteristics of the study group 109 4.1.2 Preoperative clinical characteristics 110 4.1.3 Preoperative subclinical characteristics 112 4.2 INTRAOPERATIVE CHARACTERISTICS 119 4.2.1 Characteristics of some lesions of the heart identified intraoperatively 119 4.2.2 Surgical specification 120 4.2.3 Characteristics of intraoperatively cardiac resuscitation 124 4.2.4 Early results after mechanical mitral valve replacement surgery with preservation of subvalvular apparatus 126 4.3 POSTOPERATIVE MONITORING, INSPECTION, ASSESSING THE RESULTS 131 4.3.1 Clinical characteristics 131 4.3.2 Development of paraclinical characteristics in the postoperative period 132 4.3.3 Complications in the postoperative discharge period 141 CONCLUSION 144 RECOMMENDATIONS 147 LIST OF WORKS TO DISCLOSURE RESEARCH RESULTS OF THESIS THEME 148 REFERENCES APPENDIX LIST OF ABBREVIATIONS No Abbreviation Full English writing ACC American College of Cardiology AHA American Heart Association ASA American society of Anesthesiologist pt parterners EACTS European Association for Cardio-Thoracic Surgery EF Ejection Fraction ESC European Society of Cardiology Ao Aorta PA Pulmonary artery 10 et al et alia 11 LVEDd Left Ventricular End Diastolic Dimension 12 LVEDs Left Ventricular End Systolic Dimension 13 EnT Endotracheal 14 RA Right atrium 15 LA Left atrium 16 NYHA New York Heart Association 17 PAPs Pulmonary Artery Pressure systolic 18 Pre - op Preoperative 19 Post - op Postoperative No Abbreviation Full English writing 20 AF Atrial fibrillation 21 ECC Extracorporeal circulation 22 RV Right ventricle 23 TT Left ventricle 24 TV Tricuspid valve 25 MV Mitral valve 26 WHO World Health Organization LIST OF TABLES No Name of tables Page 2.1 NYHA classification of heart failure 46 2.2 Severity grade of mitral stenosis 49 2.3 Severity grading of mitral regurgitation 50 2.4 Severity grading of tricuspid regurgitation 50 2.5 Pressure gradient across the prosthetic mitral valve 54 2.6 Degree of para-prosthetic valve regurgitation 54 3.1 Age and gender 72 3.2 Characteristics of some anthropometric indicators 73 3.3 Anamnesis 73 3.4 Relationship between gender and severity of heart failure according to NYHA 74 3.5 Characteristics of some Pre - op general clinical symptom 75 3.6 Characteristics of electrocardiogram and chest X-ray 75 3.7 Characteristics of the image of the mitral valve apparatus on Pre - op echocardiography 77 3.8 Heart morphological and functional characteristics on Pre - op echocardiography related to mitral valve disease types 78 3.9 Characteristics of some combined lesions on Pre - op echocardiography 79 3.10 Thrombosis in the LA appendage was determined intraoperatively 80 3.11 Characteristics of MV injury determined intraoperatively 81 3.12 Techniques to cut, repair and preserve the leaflets of the mitral valve in mitral valve replacement surgery 83 3.13 Components of the mitral valve and subvalvular apparatus are preserved 84 No Name of tables Page 3.14 Type and size of mechanical valve used in mitral valve replacement surgery 85 3.15 Other techniques used during mechanical mitral valve replacement surgery with posterior leaflet preservation 86 3.16 Ao clamping time, ECC time (minutes) 87 3.17 Heart rate characteristics after Ao clamp release 87 3.18 Post - op time characteristics 88 3.19 The relationship between the time of Post - op ventilator with the level of NYHA and the status of Pre - op AF 89 3.20 Correlation between Post - op ventilator time with some factors 89 3.21 The relationship between the time of Post - 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