131例主动脉瓣及二尖瓣联合瓣膜置换治疗风湿性多瓣膜病变

目的探讨提高主动脉瓣及二尖瓣联合瓣膜置换治疗风湿性多瓣膜病变疗效的方法。方法1998年7月至2005年11月8年间,对131例风湿性多瓣膜病变患者施行外科治疗。男54例,女77例,年龄21~63岁,平均42.5±4.5岁。术前心功能Ⅲ~Ⅳ级者112例(占85.50%)。21例同期行Devega法三尖瓣成形。结果痊愈124例(占94.66%),死亡7例,(占5.34%),手术后存活病人心功能明显改善。结论对于严重风湿性多瓣膜病变的患者,加强围术期处理,改善病人的营养状况,选择适当的手术时机,改善心肌保护,提高手术技巧,积极纠治三尖瓣关闭不全,可提高主动脉瓣及二尖瓣联合瓣膜置换的疗效。

Results of 131 combined mitral and aortic valve replacement for rheumatic valvlar disease

Objective To summarize the experience with 131 combined mitral and aortic valve replacement for rheumatic valvlar disease for improving the effect of surgical treatment.Methods Between July 1998 and November 2005, 131 patients who were rheumatic heart disease underwent combined mitral and aortic valve replacement. There were 54 males and 77 females ,the mean age was 42.5±4.5 year-old (range, 21~63 year-old). 85.50% of patients were in NYHA Ⅲ~Ⅳ befor operation. 21 patients were performed Devega annuloplasy. Results The hospital mortality was 5.34%(7 patients) overall. In the survival patients, the heart function was improved, significantly.Conclusion To have the better outcome of combined mitral and aortic valve replacement for rheumatic heart disease, we consider the importance is to have the proper perioperative management, to have well-timed surgical therapy, to improve the techniques of extracorporeal circulation, surgical treatment and nurtritional status, to carefully correct tricuspid regurgitation with annuloplasy.