Despite the development of a surgical procedure and postoperative management, the operative mortality in patients with cardiac cachexia associated with advanced mitral valve disease remains high. Many authors have evaluated the risk factors affecting outcome and advocated strategies for patients with cardiac cachexia.
The purpose of this retrospective study was to investigate the risk factors involved in operative mortality, with an emphasis on preoperative nutritional support and the surgical strategy for giant left atrium.
During the period from January 1982 to December 1990, we operated on 25 patients with cardiac cachexia associated with a long history of advanced mitral valve disease. Mitral valve lesions in these patients included mitral valve regurgitation in 15 patients and mitral valve stenosis in 10 patients. The age distribution was 44 to 68 years, with an average of 58 years. Twelve of the patients were men and 13 were women. As the criteria of cardiac cachexia was previously reported by our group, all patients had severe congestive heart failure (New York Heart Association [NYHA] class 4), moderate or advanced tricuspid valve regurgitation, a long history of congestive heart failure (longer than 20 years), cardiomegaly (greater than 0.80 in cardiothoracic ratio), body weight loss less than 80 percent, and hepatosplenomegaly (Table 1). canadian pharmacy mall
Cardiac catheterization data demonstrated moderate or advanced tricuspid regurgitation associated with mitral valve disease, low cardiac indices, and poor left ventricular contraction (Table 2). Echocardiography showed enlargement of the left atrium in all patients. The diameter of the left atrium ranged from 6 to 14 cm (mean, 10 ±2.0 cm) and 18 patients had giant left atrium. In these patients with giant left atrium, there was echocardiographic or angiographic evidence of aneurysmal enlargement of the left atrium. This definition was in accordance with the report of Piccoli et al.
Table 1—Criteria of Cardiac Cachexia in Patients With Mitral Valve Diseases
|Major Symptoms||Minor Symptoms|
|New York Heart Association class 4||Chronic hepatic failure|
|Advanced tricuspid regurgitation||Chronic renal failure|
|A history of CHF longer than 20 у||Ventilatory failure (%VC, FVEi)|
|Cardiomegaly greater than 0.80 in CTR||Ascites|
|Percent body weight less than 80 percent||Anemia or thrombocytopenia|
Table 2—Hemodynamic Data in Patients With Cardiac Cachexia
|RAP, m, 19 ±6 mm Hg||LVEDP, 10 ± 3 mm Hg|
|RAP, v, 25 ±8 mm Hg||EF, 42 ±7 mm Hg|
|RVP, s, 52 ±13 mm Hg||CO, 2.7 ±0.7 L/min|
|RVEDP, 14 ±5 mm Hg||Cl, 1.9 ±0.4 L/m2/min|
|PAP, s, 55 ±10 mm Hg||MVG,*t 28 ±5 mm Hg|
|PCWP, m, 25 ±9 mm Hg PCWP, v, 36 ±11 mm Hg||MVA,*f 0.7±0.3 cm2|