巨大心脏瓣膜置换术的经验

目的 总结65例巨大心脏瓣膜疾病患者的瓣膜置换术的治疗经验。方法 巨大心脏瓣膜疾病患者65例,均在中度低温体外循环下进行手术,采用透析型人工肾超滤技术,心肌保护采用温氧合血停跳液诱导停搏及终末再灌注,4℃冷晶体间断灌注维持停搏技术。单纯二尖瓣置换术45例,均保留瓣下结构(MVR/SVP),主动脉瓣置换术7例,二尖瓣及主动脉瓣联合置换术13例,同时行三尖瓣Devega环缩术20例。结果 全组患者中54例心脏自动复跳,11例电击除颤复跳。3例死亡,2例出现顽固性低心排综合征死亡,1例因凝血功能障碍致创面广泛出血死亡,其余均治愈出院。结论 治疗经验:①充分术前准备;②采用超滤技术;③采用温氧合血停跳液诱导停搏及终末再灌注,4℃冷晶体间断灌注维持停搏心肌保护技术;④采用保留瓣下结构的二尖瓣置换术(MVR/SVP)。

The experience of valve replacement for bucardia

Objective To summary the experience of the valve replacement for bucardia. Methods All 65 patients affected valvular heart disease who had bucardia were undergone the valve replacement with middle hy- ?pothermic cardiopulmonary bypass (CPB) . Ultrafiltration was used after hemodynamic stability. The myocardial protection methods were warmly oxygenated blood inducing cardial arrest, intermittent 4 t cold crjstalloid cardio-plegia perfusion and final perfusion of warm blood. MVR was performed with preservation of the subvalvular structure in 45 cases, AVR was performed in 7 cases, DVR was performed in 13 cases. Devaga annuloplasty was performed at the same time in 20 cases. Results The heart beat resumed spontaneously in 54 cases. 3 patients died, 2 patients died of obstinate low output syndrome and l patient died of bleeding due to abnormality in coagulability. Conclusion Our experience includes: 1. sufficient preparations of preoperation. 2. ultrafiltration in CPB. 3. warm oxygenated blood inducing cardial arrest, intermittent 4 t cold crystalliod cardioplegia perfusion and warm blood final reper-fusion. 4. MVR with presrvation of the subvalvular structure.