保留后瓣及瓣下结构的二尖瓣替换术9例报告

保留后瓣及瓣下结构的二尖瓣替换术９例报告徐宏耀张玉斌贾奎刘健１９８８年３月～１９９４年１２月，我院共做二尖瓣替换术３７例，均为风湿性心脏病。其中近３年做了保留后瓣及瓣下结构的二尖瓣替换术９例，与同期的１０例常规二尖瓣替换术相比有明显的优越性，现报告如...     

原发性感染性心内膜炎的外科治疗（附102例报告）

回顾性分析原发性感染性心内膜炎１０２例，其中主动脉瓣病变７１例，二尖瓣病变１６例，主动脉瓣与二尖瓣联合病变６例，三尖瓣病变５例，肺动脉瓣病变４例。按照病人术前心功能状态，分为：（１）急性心功能不全组（２５例）；（２）慢性心功能不全组（７７例）。施行主动脉瓣替换术７１例，二尖瓣替换术１６例，双瓣替换术６例，三尖瓣修复成形术５例，肺动脉瓣成形术４例。术后早期死亡９例（８．８％）。９３例生存者随访时间３个月～１６年，平均随访时间４．３年。晚期死亡６例，其中２例为人工瓣膜心内膜炎，复发率为２％。作者对手术时机与手术方式的选择作了讨论，并介绍了围术期处理的经验。     

二尖瓣替换术保留瓣叶及瓣下结构37例

二尖瓣替换术保留瓣叶及瓣下结构３７例梁智星，李大奇，孙长恩，高南翔，郭建军，梁法禹行二尖瓣替换术时保留瓣叶和瓣下结构对维护左室张力环、维持心肌收缩功能和防止左心室破裂有重要作用［１～３］。我们自１９９０年１２月至１９９２年１０月连续行保留瓣叶及瓣下结...     

无支架异种生物瓣膜主动脉瓣替换术后左室功能变化

评价无支架异种生物瓣膜主动脉瓣替换术后２年左室功能的变化。将８０例同期施行主动脉瓣替换病人分为２组，５０例（年龄６９．３±９．３岁）应用ＴｏｒｏｎｔｏＳＰＶＴＭ瓣；３０例（年龄７１．６±７．７岁）作为对照组接受支架人工瓣膜替换。术前、术后１、６、１２及２４个月间记录Ｍ型及Ｄｏｐｐｌｅｒ超声心动图，采用计算机图像数字分析，定量测定左室功能的变化。随访期间，Ｔｏｒｏｎｔｏ组主动脉瓣跨瓣压差为０．８±０．６ｋＰａ（６．０±４．５ｍｍＨｇ），明显低于对照组２．３±０．９ｋＰａ（１７．３±６．８ｍｍＨｇ）；术后１个月，左室心肌质量下降２５％，左室＋Ｖｃｆ及－Ｖｃｆ明显增加（２．０±０．８／１．４±０．３ｓ－１，Ｐ＜０．０１；２．８±１．２／１．８±０．７ｓ－１，Ｐ＜０．０１）。术后６个月，左室功能进一步改善，心室肥厚的消退更趋完全，该变化在其后的随访期间保持稳定。结论：与支架瓣膜相比，无支架异种生物瓣膜具有较大瓣口开放面积及低跨瓣压差，这促进了术后左室功能的恢复及病理性肥厚的逆转     

小创伤瓣膜外科临床实践

我们自１９９６年１０月至１９９７年７月成功施行小切口二尖瓣人工瓣膜替换术１０例，二尖瓣成形术１例。现报告如下：临床资料全组病人中男３例，女８例；年龄９～４５岁，平均３６岁。均为二尖瓣病变，二尖瓣狭窄合并关闭不全１０例，其中合并左房血栓３例，三尖瓣关闭...     

80例双瓣替换术的体会

自１９８６年９月至１９９３年７月，为风湿性心脏瓣膜病人施行主动脉瓣，二尖瓣双瓣替换术８０例，手术死亡率３．７５％（３／８０）。８０例中男３８例，女４２例，年龄平均３５．４３岁，心功能Ⅱ级２例，Ⅲ级４５例，ＩＶ级３３例。围术期行血流动力学监测７２例。本组术后发生多脏器功能不全６例。作者对双瓣替换术中常遇到的难点及处理，术后多脏器功能不全（ＭＯＤ）的防治以及如何降低手术死亡率等问题进行了讨论。     

保留二尖瓣装置的二尖瓣替换术

自１９９１年１１月至１９９４年４月，我们行保留二尖瓣装置的二尖瓣替换术５０例。男１５例，女３５例。年龄２０～５４岁，瓣膜病变均为风湿性。其中主动脉瓣和二尖瓣双瓣替换术９例，二尖瓣替换术４１例，本组病例全部存活。术后３周用超声多普勒检测心功能，５０例均显示心功能良好，ＣＩ、ＳＶ、ＣＯ、ＥＦ均明显优于同期施行常规切除瓣下装置二尖瓣替换术的病人。文中对该种手术方法、适应证及注意事项进行了讨论。     

感染性心内膜炎伴瓣膜病变的外科治疗

自１９８９年９月～１９９３年７月对２０例感染性心内膜炎伴瓣膜病变病人施行瓣膜替换术，其中主动瓣替换术８例二尖瓣替换术６例，双瓣替换术６例，无手术死亡，随访３～３８个月疗效满意，作者认为瓣膜替换术对治疗感染性心内膜炎心瓣膜失功者，是一种有挽救生命方法，并对手术时机的选择及术前后抗生素应用进行讨论。     

微创心脏瓣膜替换术73例报告

目的介绍一种微创心脏瓣膜替换术的新方法。方法于１９９７年３月至１９９８年４月为７３例瓣膜患者经右侧腋下胸部小切口,皮切口平均长度为（８５±０９）ｃｍ,进行了心脏瓣膜替换手术。结果平均循环阻断时间（８８６±３３８）分钟,平均转机（１１７０±４５９）分钟,有５例患者未阻断升主动脉,室颤下完成了二尖瓣替换术。术后气管插管时间（９６±３６）小时,平均胸液引流量（２６４５±１８４３）ｍｌ。１例患者院内死于脑出血。随诊中２例患者出现感染性心内膜炎,其中１例患者死亡。其他随诊良好。结论微创心脏瓣膜替换术安全可靠,可减少手术对患者的影响,利于患者恢复,同时为换瓣手术技术的改进提供了新经验。     

风心病二尖瓣狭窄合并小左心室的瓣膜替换术

１９８７～１９９３年３８９例二尖瓣狭窄（ＭＳ）行二尖瓣替换术（ＭＶＲ）的病人中有小左室者１２６例，其中左室萎缩２８例。心功能ＩＩＩ级７６例、ＩＶ级３５例，重度肺动脉高压６４例。手术死亡率９５％，明显高于同期非小左室病人。主要死亡原因为右心衰、急性左心衰及瓣膜功能障碍。晚期死亡率为１６％／病人－年，１、５年生存率为９６５％和８８４％。术后心脏超声显示小左室及左室萎缩者均出现左室构形和功能的重建，后者重建过程较长。结果表明，小左室主要影响术后早期效果，重度ＭＳ合并小左室，尤其是伴有严重肺动脉高压及左室萎缩，是手术的高危指标。     

Delayed rupture of the left ventricle after mitral valve replacement with bioprosthesis.

Rupture of the posterior ventricular wall after mitral valve replacement is a complication rarely reported in the literature. Perforation of the left ventricle after mitral valve replacement with a bioprosthesis has been described in only 3 patients. We have had 2 patients with this complication out of 322 patients who had mitral valve replacement with bioprosthesis. These perforations were caused by impingement of the posterior strut of the bioprosthesis on the posterior left ventricular wall, with intramyocardial hematoma and delayed rupture of the left ventricle.     

Rupture of the posterior wall of the left ventricle after mitral valve replacement: etiological and technical considerations

Rupture of the posterior wall of the left ventricle after mitral valve replacement, although infrequent, may be a highly lethal complication. Controversy exists regarding the etiology of this complication. Suggested causative factors include the type and extent of the valvular disease, type and size of the prosthesis, and the surgical techniques used. Our experience over a 20-year period includes 10 patients with rupture of the left ventricle following mitral valve replacement. In all patients, both mitral leaflets were excised together with the attached chordae. Three patients survived after repair of the rupture. Repair consisted of compressing the area between the left atrium and the base of the papillary muscle using two strips of Teflon and deep mattress sutures passed beneath the coronary vessels in the atrioventricular groove. Since 1983 we have routinely preserved the posterior leaflet of the mitral valve with its attached chordae to maintain a "tethered loop" between the mitral valve and ventricle. No further ruptures have occurred. The technique used for repair represents reconstitution of the divided loop between the ventricle and the mitral valve.     

Rupture of the posterior wall of the left ventricle after mitral valve prosthesis]

Rupture of the posterior wall of the left ventricle after mitral valve prosthetics is a rare (0.6%) but a dangerous and death-threatening complication. Injury to the fibrous ring in the anatomically hazardous zone (at 4-5 o'clock of an imaginary clock-face) is the most frequent cause of the ruptures. Surgical correction of this complication will be successful only with the use of extracorporeal circulation and repeated cardioplegia. Preservation of the posterior cusp and subvalvular apparatus is a reliable measure preventing rupture of the posterior wall of the left ventricle.     

Use of Bovine Pericardium and Sutureless Biological Glue in Left Ventricular Rupture After Mitral Valve Replacement,Five Years of Follow-up

Rupture of the left ventricular wall after mitral valve replacement is an infrequent but lethal complication. Reporting correction technique of ventricular rupture with bovine pericardium patch secured with glue and without suturing: a 51 years-old female patient, with double rheumatic mitral lesion, severe stenosis and discrete insufficiency, who had a mitral valve replacement. During surgery, the patient presented a ventricular rupture of the posterior wall (atrioventricular disruption), which was successfully repaired using bovine pericardium with sutureless biological glue over the epicardium of the damaged area. Sixty months after surgery the patient has no symptoms.     

A technique to repair type I left ventricular rupture following mitral valve replacement

Rupture of the posterior left ventricle is a serious complication following mitral valve replacement. A successful method of repair is illustrated. The causes, other methods of repair, and means to prevent this complication are discussed.     

Delayed left ventricular free wall rupture complicating coronary artery bypass surgery. A case report

Rupture of the left ventricular free wall is a not uncommon life-threatening complication of acute myocardial infarction and after prosthetic mitral valve replacement. To our knowledge, no case of left ventricular rupture after coronary artery bypass surgery has been reported. A case is now described in which coronary artery bypass grafting was complicated by delayed rupture, which was successfully repaired. Different etiologic factors are discussed, but the cause considered most likely was trauma from elevation of and traction on the heart in exposure of its posterior aspect.     

Repair of left ventricular rupture after mitral valve replacement: use of a Teflon patch and glue

Rupture of the left ventricular wall is an infrequent but lethal complication after mitral valve replacement. We present the case of a patient in whom such a rupture was successfully repaired in the intensive care unit with a patch of Teflon felt stuck in place with glue.     

Successful repair of post-operative rupture of the left ventricular wall after mitral valve replacement

Rupture of the left ventricular wall after mitral valve replacement (MVR) is a rare but lethal complication, particularly in delayed type. We have encountered five cases of this complication, and the last case who was suffered 6 hours after MVR was successfully repaired. This case is a 56-year-old woman with MS. She underwent MVR with a Duromedics 25 M. She was transferred to the ICU and the postoperative course was uneventful until 6 hours after the operation, then bleeding from chest drainage tubes increased suddenly. She was promptly brought to the operating room, and the cardiopulmonary bypass was restarted. A tear and hematoma at the posterior wall of the left ventricle (Type II perforation) were found. The rupture was closed with three interrupture mattress sutures with a teflon felt strip. Bleeding was decreased, but oppression with sponge was applied to small but continuous bleeding. At present, she is in a good condition without occurrence of pseudoaneurysm of the left ventricle. We investigated our own five cases and sixty cases reported in Japan, and etiology, surgical repair and prevention of this complication were discussed.     

Rupture of posterior wall of left ventricle after mitral valve replacement

Possible aetiological factors, presentation, and management were reviewed in 18 patients with posterior left ventricular rupture complicating mitral valve replacement seen at one centre over six and a half years. The patients were elderly (mean age 57), predominantly women (16 of the 18), and suffering from mitral stenosis. Rupture was much more common after isolated replacement of the mitral valve (16 out of 797 operations) than after double valve replacement (one out 236) or mitral valve replacement and coronary artery bypass graft (one out of 70). A total of 1221 mitral valve replacements were performed over this period, with an overall incidence of rupture of 1.47%. Damage to the valve annulus occurred five times. On four occasions haemorrhage followed a vigorous response to a bolus dose of an inotrope. With the exception of these features, it was difficult to define specific risk factors. Eleven patients bled while still in theatre; one of them survived long term and another four lived for four to 10 days. Repair after restarting cardiopulmonary bypass made short term survival much more likely. In seven rupture developed after return to the intensive therapy unit; again only one survived long term. In nearly all cases bleeding was at, or just below, the atrioventricular groove. Rupture probably occurs after endocardial damage to a thin myocardium that has lost the internal buttress of the subvalvar apparatus. With the rise in intraventricular pressure at the end of bypass blood dissects into the myocardium, resulting in a large haematoma and eventual rupture.     

Type I left ventricular rupture after mitral valve replacement

Rupture of the left ventricle in the atrioventricular (AV) groove is a rare and usually fatal complication of mitral valve replacement (MVR). The successful repair of a delayed type I left ventricular rupture is described. The technique of repair is described, the literature reviewed, and three further cases from the authors' experience are reported.