危重心脏瓣膜病瓣膜替换有关问题探讨

目的探讨危重心脏瓣膜病的外科诊断标准,总结其治疗经验。方法对1980年1月~2004年2月施行的危重心脏瓣膜病瓣膜置换术254例进行回顾性总结分析,其中男性120例,女性134例;年龄12~73岁;术前心功能III级82例,IV级172例;二尖瓣置换158例(57例为再次手术),主动脉瓣置换14例,二尖瓣 主动脉瓣置换82例。全部病人置入瓣膜均为机械瓣。同时施行三尖瓣成形82例,左房血栓清除30例,左房成形20例,冠状动脉搭桥3例,经主肺动脉内关闭未闭动脉导管6例,室间隔缺损修补4例,主动脉窦瘤破裂合并室间隔缺损修补及异常传导束切割各2例。结果早期死亡13例(5.1%),低心排出量综合征、呼吸衰竭及心室纤颤为最常见的死亡原因。结论注重术前准备,选择适当手术时机,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 serious patients

Objective To study the diagnostic standards of critical cardiac valve disease and to summarize the experience of its surgical treatment.Methods Valve replacements were performed in 254 cases of critical cardiac valve diseases from January 1980 to February 2004.There were 120 males and 134 females,with an age range from 12 to 73 years.Preoperative heart function(NYHA) was class III in 92 cases,and class IV in 172 cases.Mitral valve replacement was performed in 158 cases,in which closed mitral commissurotomy had been done before valve replacement in 57 cases.Aortic replacement was performed in 14 cases and both mitral and aortic replacement in 82 cases.Mechanical valves were employed to all the patients.Associated procedures were tricuspid annuloplasty in 82 cases,left atrium thrombectomy in 30 cases,annuloplasty in 20 cases,and coronary artery bypass grafting in 3 cases,closing of patent ductus arteriosus transpulmonary artery in 6 cases,repair of ventricular septal defect in 4 cases,and repair of aneurysm of the sinus with ventricular septal defect and surgical interruption of the bundle of Kent in patient with W-P-W syndrome were performed in 2 cases respectively.Results The early death was 13 cases(5.1%).Low cardiac output,ventricular fibrillation and respiratory failure were the most frequent causes of mortality.Conclusions In order to increase the efficacy of surgical treatment for the serious patients,we should pay more attention to preoperative preparation,appropriately operative chance,correct pathological changes,avoid operative complications,and strengthen management of postoperative complications.