左心房折叠术在二尖瓣病变合并巨大左心房治疗中的应用

目的探讨左心房折叠术治疗二尖瓣病变合并巨大左心房的临床应用效果.方法回顾性分析23例收缩末期左心房内径为(129±37)mm (92～250 mm)、行左心房折叠术的二尖瓣手术患者的临床资料.22例选用人工机械瓣膜置换,1例为生物瓣置换,同期行左心房折叠术.术前心功能NYHA分级,Ⅲ级15例,Ⅳ级8例;术前心胸比为0.79±0.10.单纯二尖瓣置换术18例,其中行三尖瓣成形术10例;双瓣膜置换和三尖瓣成形术5例,其中二次手术2例, 术中行心房纤颤射频消融术2例.结果术后低心排出量综合征3例(13%),呼吸衰竭2例(9%).早期死亡3例(13%),其中2例为低心排出量综合征、1例为脑梗死.术后失访2例,术后1年意外死亡1例,平均随访(44±39)个月,17例生存患者心功能Ⅰ级14例、Ⅱ级3例;术后心胸比为0.68±0.11,较术前明显缩小(t=3.80,P=0.000).结论在瓣膜病手术的同时对巨大左心房症行左心房折叠术,可减少术后并发症,术后效果良好.

Left atrial plication for left atrium associated with mitral valve disease

OBJECTIVE: To evaluate the effects of left atrial plication (LAP) in patients with giant left atrium (GLA) associated with mitral valve disease. METHODS: Twenty-three patients with left atrial diameter (LAD) over 8.0 cm were enrolled. All cases underwent valve replacement and LAP between November 1993 and November 2004 were studied retrospectively. According to New York Heart Association (NYHA) classification, 15 belonged to class III, 8 to class IV. Mitral valve replacements were performed in 18 patients (mechanical valve in 17 and biological valve in 1), double value replacement in 5, tricuspid valve plasty (TVP) in 15, atrial fibrillation radiofrequency ablation in 2. RESULTS: Low output syndrome happened in 3, respiratory failure in 2. The early death was in 3 cases (operative mortality 13%). The causes of death were: heart failure in 2 cases and stroke in 1. LAD was decreased significantly in patients after operation. CONCLUSIONS: LAP has considerably beneficial effects on improvement of postoperative respiratory and cardiac function, reducing operative mortality. Atrial fibrillation radiofrequency ablation is effective in patients with GLA associated with valve disease. It may be recommended for patients with GLA during mitral valve surgery, especially for patients with LAD > 8.0 cm.