The patients with mechanical prosthetic valve replacement need anticoagulant therapy for all their life. The incidence of thromboembolism and anticoagulation-related bleeding events still account for major postoperative complications after mechanical heart valve replacement. Most of the complications happen in the first half year after operation. Therefore, early anticoagulation therapy is very important. Of course, so far most guidelines focus stating their opinions on long-term anticoagulant therapy. However, there is no consensus about anticoagulant therapy in the early period of postoperation. In this review, we summarize early anticoagulant therapy of the patients with mechanical heart valve replacement through consulting domestic and abroad relevant research in recent years and give an overview of the present situations of early anticoagulant therapy.
Atrial fibrillation （AF） as a most frequent arrhythmia has a high incidence of 79% in patients with mitral valve disease. Thrombosis, embolization and serious arrhythmia can be caused by AF. There is the recrudescent tendency in using drugs to recover the sinus rhythm, surgery and radio frequency ablation can only cure a part of patients. By now the pathogenesis of AF is not known clearly. The pathogenesis of AF from virulence gene, cardiac electrophysiology, connecxins, cell ultramicrostructure and cell signaling system are reviewed in this article.
Objective To investigate the correlation between the left atrial hydrodynamic change and atrial fibrillation (AF) in the patients with rheumatic mitral stenosis. Methods According to cardiac rhythm before operation, 49 patients with rheumatic mitral stenosis accompanying chronic AF were divided into two groups,group A: AF, 25 cases; group B: sinus rhythm, 24 cases. Control group : 29 healthy volunteers were examined. By using echocardiography, left atrial hydrodynamics were tested, and repeated 6-8 months after the operation. Results Left atrial stress (LAS), left atriala area (LAA) and left atrial volume(LAV) in group A after operation was much lower than before operation, LAS after operation in group B was also lower than before operation(Plt;0.01). Before operation, LAS in group A was significantly lower than that in group B, LAA and LAVwere larger. After operation, LAA and LAV in group A were significantly larger than those in group B(Plt;0.01). LAS, LAA and LAV in group A and group B before and after operation were higher than those in control group. Conclusion Left atrial hydrodynamic enviroment in patients with mitral stenosis has not reached normal even after valve replacement, LAS may be an important factor of causing AF.