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.
Journal of military pharmaco-medicine n08-2017 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 228 Journal of military pharmaco-medicine n08-2017 SUBJECTS AND METHODS 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 Methods Shortness of breath on exertion 96.7 Palpitations 92.6 Arrhythmia 65.6 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 - 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) 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 * 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 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 - RESULTS AND DISCUSSION 90%) [8] Because It was the first stage of Clinical characteristics Table 1: Some clinical and historical characteristics (n = 122) open heart surgery at 108 Military Central Hospital, intensive care unit (ICU) of heart located on the same place with ICU of Clinical characteristics, medical history Anamnesis of rheumatic fever Anamnesis of mitral valve intervention NYHA class Rate (%) general hospital Therefore, it would be Treatment 48.4 very difficult to care patients with NYHA IV No treatment 20.5 Closed heart surgery 5.7 of breath on exertion, palpitations (> 92%) Percutaneous balloon mitral valvotomy 16.4 and arrhythmia (65.6%), that were similar II 65.6 be due to patients’ anxiety of surgery and III 34.4 family’s financial economy [2] with many complications after surgery The main symptoms included shortness to many other studies The cause might 229 Journal of military pharmaco-medicine n08-2017 Some paraclinical characteristics of mitral valve disease Table 2: Some major paraclinical characteristics (n = 122) Paraclinical features Electrocardiogram Echocardiography Rate (%) Sinus rhythm 34.4 Atrial fibrillation 65.6 Very severe mitral stenosis 0.0 Severe mitral stenosis 62.2 Severe mitral valve regurgitation 9.0 Severe systolic pulmonary artery hypertension 13.1 Thrombosis of atrium 31.9 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 scores ≥ points 100% * The size of SJM valves (n = 122): Size 27: 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 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 ≥ 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 230 Some characteristics in the operation Mean Aortic crossclamp time 30 180 60.3 ± 26.5 CPB time 48 224 95.6 ± 32.1 Operative time 74 250 123.5 ± 33.5 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 Journal of military pharmaco-medicine n08-2017 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 Đo n u c Hưng, h m u c Đ t, Nguyễn H u c Kết s a van ba điều trị bệnh van tim m c phải ệnh viện H u nghị iệt ức Tạp ch Tim mạch học iệt Nam 2013, 64, tr.1-10 Nguyễn Đức Hiền, Bùi Đức Phú ánh giá kết phẫu thuật thay van hai học bệnh nhân hẹp van hai Hội nghị Phẫu thuật Tim mạch L ng ng c iệt Nam 2011, tr.1233-1239 Nguyễn Văn han Nh ng yếu tố liên quan đến định can thiệp bệnh hở van ba đ ng thời phẫu thuật van hai Viện Tim TP H Chí Minh Tạp chí Phẫu thuật Tim mạch L ng ng c 2014, 4, tr.3-8 Ph m Nguyễn Vinh Bệnh học tim mạch Nhà xuất Y học, TP H Chí Minh 2003, tr.205- 255 Carpentier A, Adams D.H, Filsoufi F Reconstructive Valve Surgery Sauders Elsevier, French 2010 Lawrence H Cohn Cardiac Surgery in the Adult McGraw - Hill Global Education, New York, USA 2008 Katlic M.R Cardiothoracic Surgery in the Elderly Springer Science + Business Media, New York, USA 2011 Kouchoukos N.T, Blackstone E.H, Doty D.B et al Cardiac Surgery Churchill Livingstone, Saltlake, USA 2010 World Health Organization Rheumatic fever and rheumatic heart disease Report of a WHO Expert Consultation Geneva 2004, pp.1-122 231 ...Journal of military pharmaco-medicine n08-2017 SUBJECTS AND METHODS Subjects 174 patients were diagnosed as mitral valve disease and received mitral valve replacement with SJM valves at 108 Military. .. surgery at 108 Military Central Hospital, intensive care unit (ICU) of heart located on the same place with ICU of Clinical characteristics, medical history Anamnesis of rheumatic fever Anamnesis of. .. 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 * Statistical