MVR is a type of heart surgery primarily used to treat mitral valve diseases, including mitral stenosis and mitral insufficiency[16]. The history of this procedure dates back to the early 20th century, but the real development and successful application dates back to after the mid-20th century. However, with the development of technology, MVR has gradually become an important treatment option[17, 18]..In this procedure, a patient's damaged or diseased mitral valve is replaced with an artificial valve to restore heart function. The important role of MVR is to solve the problems of heart failure and arrhythmia caused by mitral valve disease, so as to improve the quality of life and extend the life span of patients. This procedure has become one of the main treatments for severe mitral valve disease, offering patients an effective treatment option. Left ventricular end-diastolic volume and left ventricular end-diastolic diameter have always been the common concerns of surgeons and sonographers, but the quality of left ventricle in MVR is easy to be neglected in clinical work. After MVR, LVM may change, including left ventricular remodeling, left ventricular hypertrophy and left ventricular dilation. These changes may have an impact on the survival rate of postoperative patients and the incidence of cardiovascular events. There are many indicators such as perioperative left ventricular geometry, and LVM is often ignored as an indicator[19].In this study, we mainly focused on the difference between different disease types, LVM, and the change trend of postoperative LVM.LVM can represent the comprehensive evaluation of perioperative heart geometry and size, and left ventricular adaptation to chronic volume overload occurs with the gradual enlargement of ventricles and the increase of LVM[20]. Chronic severe volume overload can change the shape of the left ventricle and increase the mass of the left ventricle, which is also related to the size and volume of the left ventricle. In the above patients, the increase of the mass of the left ventricle often indicates that the patient has congestive heart failure. For congestive heart failure, centrifugal dilation of the heart is often accompanied by abnormal cardiac conduction bundles. The coordination of the heart and the effectiveness of pumping blood are affected. It has been reported in relevant literature that patients with congestive heart failure are more prone to arrhythmia[19, 21], which seriously affects the quality of life of patients.
As can be seen from the above table, there is a significant difference in the heart structure changes caused by rheumatic heart disease and degenerative valvular disease. The LVM of patients with rheumatic heart disease is lighter than that of patients with degenerative valvular disease, and the end-diastolic volume and end-systolic volume of left ventricle in rheumatic heart disease are smaller than those in degenerative valvular disease. This may be due to the fact that mitral valve damage caused by rheumatic heart disease is not only regurgitation, but also narrowing caused by coiled fusion of the lobes [22–24]. However, degenerative valvular disease is mainly caused by left ventricular centrifugal dilation due to enlarged valve ring, poor valve quality, and myxopathic valve insufficiency[25, 26]. These results suggest that isolated dilatation caused by valve insufficiency alone has a greater effect on LVM increase. The LVM of the patient before and after MVR has obvious changes, and the LVM, the size and volume of the left ventricle of the patient after surgery have all changed. As can be seen from the above picture, mitral valve function is restored to normal. For patients with rheumatic heart disease, the LVM shows an upward trend one week after surgery; for patients with degenerative valvular disease, LVM shows an upward trend one week after surgery. LVM showed an obvious downward trend, which may be due to mitral valve damage and insufficiency accompanied by certain stenosis in rheumatic heart disease. After the patient's mitral stenosis was removed after surgery, the LVM of the patient showed an upward trend. After the patient's degenerative valvular disease was removed, the left ventricular mass decreased. Mitral stenosis decreases the LVM, while mitral regurgitation increases the LVM. As can be seen from the above table and picture, the overall postoperative LVM of patients is decreased, and the LVM regression of left ventricle after surgery is accompanied by changes in the volume and size of left ventricle. For LVM regression, it is also accompanied by the process of the myocardium reaching the optimal initial length from congestive heart failure cardiomyocytes. The LVM and volume and size of the left ventricle were not significantly changed, indicating that the geometry of the left ventricle tended to stabilize during the postoperative period.
As for clinical work, the volume and size of the left ventricle and the overall geometry of the patient appear significant changes within 1 week after surgery. At this time, more attention should be paid to the treatment of the patient's cardiac capacity and timely adjustment should be made. For congestive heart failure caused by degenerative valvular disease, preoperative attention should be paid to arrhythmias and conduction tract abnormalities caused by increased LVM caused by long-term changes in left ventricular volume and accompanying functional changes caused by changes in left ventricular structure. For rheumatic heart disease, when the problems caused by the mitral valve are removed after surgery, attention should also be paid to the changes in capacity requirements caused by the changes in the patient's early heart[27].
For the long-term complications of MVR surgery, in addition to bleeding and thrombosis caused by improper use of mechanical anticoagulant drugs related to valve materials and valve degeneration after biological valve surgery, there are also some relevant factors surrounding patient prognosis, such as: Infection in valve replacement surgery, fat liquefaction of surgical wounds, poor incision healing, Alsaddiqe, etc. [28, 29]. An additional complication is that patients still have symptoms of heart failure after surgery. Heart failure after MVR refers to a condition in which the heart cannot effectively pump blood to various parts of the body due to functional problems of the heart after MVR[30, 31]. If a patient already has chronic heart disease before surgery, they may still be at risk of heart failure after surgery, as surgery does not always fully correct the structural and functional problems of the heart[32, 33].
Developing heart failure after MVR can have a range of effects on patients' quality of life and long-term health. The patient's quality of life is reduced, daily activities may be limited, and the patient may feel unable to perform some routine tasks. Patients are at increased risk of readmission, which not only imposes a physical and psychological burden on the patients themselves, but also increases medical costs. The patient's heart function deteriorates, and the presence of heart failure may lead to further deterioration of heart function. Excessive heart burden may cause damage to the heart muscle, forming a vicious circle, and eventually lead to a gradual decline in the function of the heart, and even a threat to life.
In this study, an evaluation model was established by comparing some patients with decreased EF and normal EF after surgery. Some clinically relevant indicators were used to predict the probability of heart failure after MVR, and a column graph was drawn to assign scores related to risk factors affecting the prognosis of patients. From this study, it can be seen that the diameter of the left atrium, the end diastolic diameter of the left ventricle, LVM, and blood creatinine have certain effects on the recovery of patients. In addition to simply describing the size of the patient's left atrium, the left anterior and posterior diameter can also roughly predict the duration of the patient's disease and the severity of the lesion[34, 35]. The left ventricular end-diastolic diameter can not only describe the size of the left ventricle, but also reflect the short-term cardiac volume change. LVM mainly reflects the overall morphology of the patient's heart. LVM is a comprehensive index to describe the heart, but its role is often ignored by clinicians. In addition to reflecting the kidney function of patients, the serum creatinine value changes due to prerenal renal failure in patients with valvular heart disease accompanied by a decrease in forward blood flow. For the above risk factors, clinicians can intervene in many ways. For patients who may be associated with postoperative EF decline, in terms of left atrial size should give education to patients with mitral valve disease, so that they can receive surgical intervention as soon as possible. In terms of left ventricular end-diastolic diameter and LVM, The study can give the patient volume control before surgery if the condition permits. In terms of serum creatinine, we can try to alleviate the kidney function of the patient through drugs or volume. By improving these risk factors, we can clinically reduce the risk of postoperative EF reduction.
In this study, patients were scored based on these indicators by assigning score values to the column chart, and postoperative EF decline could be assessed by preoperative risk factors. According to the prediction model, medical staff can give corresponding preventive measures to the high-risk population, and improve the prognosis of patients has certain guiding significance for clinical.