Echocardiography of patients with secondary operation after artificial heart valve replacement

Objective To analyze the preoperative and postoperative echocardiographic changes in patients with secondary operation after artificial heart valve replacement (HVR), and to investigate the value of echocardiography in evaluating cardiac function and effect of secondary operation in patients with secondary operation after HVR.

Methods A total of 30 patients with secondary operation after HVR were selected. According to the reasons of secondary operation, the patients were divided into valve abnormality group (n=16) and severe tricuspid regurgitation after operation group (TR group, n=14). Echocardiography was performed at the time points of before operation, 1 week and 2 weeks after operation, and 3, 6 and 12 months after operation, respectively, and the changes of right heart function, tricuspid valve and TR degree were evaluated.

Results At 6 and 12 months after operation, the left atrial diameter (LAD), left ventricular diameter (LVD), maximum long axis diameter of right atrium (RA_mla), right ventricular diameter (RVD) and right ventricular free wall thickness (RVWT) in both groups were lower than those before operation, while the right ventricular fraction area change (RVFAC) was higher than that before operation (P < 0.05); the right ventricular myocardial function index (RIMP) in both groups decreased at 1 week after operation and began to rise at 3 months after operation, and the RIMP at 12 months after operation was higher than that before operation (P < 0.05); there were no significant differences in cardiac structure and right heart function between the two groups at 12 months after operation (P>0.05). At 6 and 12 months after operation, the tricuspid valve annular end diastolic diameter (TVAEDD) and the tricuspid valve annular end systolic diameter (TVAESD) in both groups were lower than those before operation, while the tricuspid annular plane systolic excusion (TAPSE) was higher than that before operation in both groups (P < 0.05). There were no significant differences in TVAEDD, TVAESD, percent shorting of tricuspid valve annulus (PSTVA) and TAPSE before and after operation between the two groups (P>0.05). At 12 months after operation, the degree of TR in both groups was significantly improved (P < 0.05). There were no significant differences in TR between the two groups at 1 week and 2 weeks after operation as well as 3, 6 and 12 months after operation (P>0.05).

Conclusion Echocardiography can be used to observe the preoperative and postoperative cardiac morphology and structure in patients with secondary operation after HVR through multiple viewpoints, comprehensively evaluate the right heart function, access the treatment effect of secondary operation, and provide reference for clinical treatment and prognosis evaluation.