Efficacy of surgical treatment for mitral and aortic regurgitation combined with enlarged left ventricle

Objective To study the medium- and long- term survival and cardiac structure and function of patients with mitral and aortic regurgitation combined with severely enlarged left ventricle （LV） after surgical treatment. Methods From January 2000 to December 2012， 41 patients （35 males and 6 females） with a mean age of （46.0±12.9） years， had undergone double valve surgery at Chinese PLA General Hospital. All patients had severely or moderately mitral and aortic valve regurgitation with left ventricular end diastole diameter （LVEDD） ≥65mm. 2 cases were in NYHA functional class Ⅰ， 7 cases in NYHA functional class Ⅱ， 23 cases in class Ⅲ and 9 cases in class Ⅳ. The mean clinical course was （17.6±12.1） years （range， 0.5 - 40 years）. Echocardiogram （UCG）showed LVEDD was （75.9±9.2） mm （range， 65.0 - 99.0 mm）， LVESD was （52.1±10.2） mm （range， 40.0 - 76.0 mm）， ejective fraction （EF） was （51.1±10.9）% （range， 23.0% - 70.0%）. Results One out of 41 cases died in the peri-operative period accounting for a mortality rate of 2.43%. Two weeks after surgery， the echocardiogram showed a reduction of LVEDD ［（75.9±9.1） mm vs.（60.8±9.9） mm， P＜ 0.05］. Follow-up was completed in 32 cases （80%）， the mean follow up term was （95.9±47.3） months （range，23 - 180 months）. 30 cases were alive with a survival rate of 93.75%. 5 out of 32 cases was in class Ⅰ（NYHA）， 19 cases in class Ⅱ，4 cases in class Ⅲ， 2 cases in class Ⅳ. 2 cases were dead during follow-up with a ratio of 6.7%， 8 cases were out of correspondence with a ratio of 20%. 1 case was dead due to cardiac events， and the main cardiac event was chronic cardiac failure. The non-cardiac event was cerebral infarction. Compared with peri-operative period， all alive cases showed further decrease of LVEDD at late control［（60.8±9.9） mmvs （52.8±8.7） mm， P＜ 0.05）］. Conclusion Surgery is an effective method for patients with mitral and aortic regurgitation combined with severely dilated left ventricles， and it can retard severe left ventricle dilation.