重症心脏瓣膜替换175例报告

目的 :探讨对重症心脏瓣膜病外科诊断标准和总结治疗经验。方法 :1980年 1月至 1998年 2月 ,对重症心脏瓣膜病施行瓣膜置换 175例 ,其中男性 80例 ,女性 95例 ,年龄 12～ 6 6岁 ,术前心功能Ⅲ级 40例 ,Ⅳ级 135例。二尖瓣置换 111例 ,其中 40例为再次手术 ,主动脉瓣置换 2例 ,二尖瓣 +主动脉瓣置换 6 2例。全组置入瓣膜均为机械瓣。同时施行三尖瓣成形 32例 ,左房血栓清除 17例 ,左房成形12例 ,冠状动脉搭桥、经主肺动脉内关闭未闭动脉导管及异常传导束切割各 1例。结果 :早期死亡 10例(5 6 % ) ,低心排出量综合征、呼吸衰竭及室颤为最常见原因。结论 :注重术前准备 ,适当选择手术时机 ,合理纠正病变 ,避免手术不当并发症及加强术后并发症处理可进一步提高外科疗效

Experience of cardiac valve replacement in 175 serious patients

Objective:This is to study diagnosis standard and summarize the experience of surgical treatment of critical cardiac valve disease.Methods:Valve replacements were performed in 175 critical cardiac valvular cases from January 1980 to February 1998.There were 80 male and 95 female,with an age range from 12 to 66 years.Preoperative heart function(NYHA) 40 cases in class Ⅲ ,and 135 cases in class Ⅳ.Mitral valve replacement was performed in 111 cases with which closed mitral commissurotomy had been done before volve replacement in 40 cases.Aortic replacement were performed in 2 and both mitral and aortic in 62.Mechanical valves were employed to all patients.Associated procedures were tricuspid annuloplasty in 32 cases,left atrium thrombectomy in 17, annuloplasty in 12,and coronary artery bypass grafting in 1 case, closing of patent ductus arteriosus transpulmonary artery and surgical interruption of the Bundle of Kent in the patient with W\|P\|W syndrome each in 1.Results:The early death was 10 cases(5.6%).Low cardiac output,ventricular fibrillation and respiratory failure were the most frequent cause of mortality.Conclusion:According to characteristic of serious patient,paying attention to preoperative preparation,appropriately operative chance and correcting pathological changes,avoiding operative complication,and strengthening management of postoperative complication may have an excellent result in serious patients.