风湿性联合瓣膜病小主动脉瓣环的外科治疗

目的：探讨风湿性联合瓣膜病小主动脉瓣环的外科治疗手术技巧的临床意义。方法：对47例联合瓣膜病小主动脉瓣环者，常规建立体外循环，采用改良联合瓣膜替换方法，先替换主动脉瓣，再替换二尖瓣。结果：小主动脉瓣环者，在不拓宽主动脉瓣环的情况下，也能替换足够大口径的人造瓣膜，未出现瓣环周围组织撕裂出血、瓣周漏及主动脉切口出血。主要并发症有：低心排3例，肺部感染2例，多脏器功能衰竭3例，其中死亡1例，死亡率2．13％。超声心动图提示术后心功能均有明显改善，左心室较术前缩小。结论：小主动脉瓣环者，如果按照常规瓣膜替换顺序，将带来瓣膜座环困难、瓣周漏、主动脉切口出血等并发症。采用改良联合人造瓣膜替换方法，能避免常规瓣膜替换法的并发症，是处理小主动脉瓣环的一种安全有效的方法。

Surgical treatment of rheumatic valvular heart disease with small aotic valve

Objective: To evaluate the clinical significance of surgical technic of rheumatic valvular heart valve disease with small aotic valve annulus. Methods: Fourty-seven patients with rheumatic valvular heart disease and small aotic valve annulus were treated surgically. After routine establishment of extracorporeal circulation, we used the modified method of valve replacement, in which mitral valve was replaced following replacement of aotic valve. Results: Prosthetic valve of sufficiently large caliber could be used to replace small aotic annulus in patient without enlarging the aotic annulus. No tissue around aotic annulus was seen to be ruptured or bleeded and no perivalvular leakage or hemorrhage of aotic incision occurred. Major complications displayed as follows: 3 cases of low cardiac output, 2 cases of respiratory infection and 3 cases of multiple organ failure, among whom 1 patient died, with a mortality rate of 2.13 % . Echocardiography indicated that cardiac function all improved and left ventricular cavity reduceed after surgery. Conclusion: It is difficult to place prosthetic valve in routine sequence of valve replacement in patients with small aotic annulus and perivalvular leakage and hemorrhage of aotic incision may occur. The modified method of combined valve replacement can help to avoid complication in routine valve replacement, which is safe and effective for managing small aotic annulus.