心脏瓣膜病并巨大左房室心脏瓣膜替换的经验

目的:探讨心脏瓣膜病并巨大左房室心脏瓣膜替换的外科手术指征、方法及围手术期处理。方法:1980年1月至2004年1月,对心脏瓣膜病并巨大左房室施行瓣膜置换156例,其中男性52例,女性104例,年龄14~69岁;术前心功能Ⅲ级52例,Ⅳ级104例。心胸比率0·70~0·94。超声心动图检查示左心室舒张末径60~94mm,左心房径62~118mm。射血分数(EF)0·26~0·65。二尖瓣置换98例,主动脉瓣置换10例,二尖瓣+主动脉瓣置换48例。同时施行三尖瓣成形42例,左心房血栓清除20例,左心房成形20例。结果:早期死亡12例(7·7%),低心排出量综合征、心室颤动、呼吸衰竭及多脏器功能衰竭为最常见原因。结论:注重手术前准备,适当选择手术时机,加强术中心肌保护及术后并发症的防治,可进一步提高外科疗效。

Experinece of cardiac valve replacement in 156 patients with giant left atrium and ventricle

Objective:This is to study appropriately operative indication,method and perioperative management of cardiac valve disease with giant left atrium and ventricle.Method:Valve replacements were performed in 156 cardiac valvular cases with giant left atrium and ventricl from January 1980 to 2004 January.There were 52 male and 104 female,with an age range from 14 to 69 years.Preoperative heart function(NYHA) 52 cases in class Ⅲ and 104 caese in class Ⅳ.Cardia/thorax was 0.70-0.94,left ventricular diastolic end dimension was 60-94 mm,left atruium dimension was 62-118 mm.EF Was 0.26-0.65.Mitral valve replacement was performed in 98 cases,Aortic valve replacement were performed in 10 and both mitral and aortic valve replacement in 48.Associated procedures were tricuspid annuloplasty in 42 caese,left atrium thrombectomy in 20,and annuloplasty in 20.Result:The early death was 12 caese (7.7%).Low cardiac output,ventricular fibrillation,respiratory failure,and multiple organ failure were the most frequent cause of mortality.Conclusion:Paying attention to preoperative preparation,appropriately operative chance, and strengthening myocardial protection and management of postoperative complication may have an excellent result in serious patients.