主动脉瓣及二尖瓣双瓣置换术48例临床观察

目的探讨主动脉瓣及二尖瓣双瓣置换术的手术方法和效果.方法全组病例在全麻、低温、体外循环下实施手术.中度血液稀释,主动脉根部灌注冷停跳液,心包腔内放置冰屑,经右心房、房间隔置换二尖瓣,主动脉根部横切口置换主动脉瓣.18例合并三尖瓣关闭不全者同期行De-Vega环缩术,9例合并左心房血栓者同期行血栓取出术,1例合并动脉导管未闭者同期行动脉导管缝闭术.结果术后低心排6例,二次开胸止血5例,放置起搏器2例,死亡2例,死亡率为4.16%.结论对风湿性心脏病主动脉瓣及二尖瓣双瓣置换患者,加强围术期处理,提高手术技巧,术中良好的心肌保护以及平稳的灌注,重视三尖瓣病变的处理和保留二尖瓣瓣下结构是手术成功的关键.

CLINICAL THERAPEUTIC EFFECTS OF REPLACEMENT OF AORTIC AND MITRAL VALVES IN 48 CASES

Objective To explore operative methods and clinical therapeutic effects of replacement of aortic and mitral valves.Methods All operations were performed under the conditions of general anesthesia,low temperature and cardiopulmonary bypass.Heart-beating inhibition solution was infused into the root of aorta and screw ice was placed into pericardial cavity.Mitral valves were replaced through right atria and atrial septum.Aortic valves were replaced through transverse incision in the root of aorta.18 cases with tricuspid insufficiency received Devega operations.9 cases with left atrial trombus underwent trombectomy.1 case with patent arterial duct was treated with arterial duct suture.Results Low cardiac output syndromes occurred in 6 cases,secondary hemostasis was made in 5 cases.Cardiac pacemakers were placed in 2 cases.Other 2 cases(4.16%) died.Conclusion The key factors in replacing aortic and mitral valves in cases of rheumatic heart disease are the effective perioperative treatment,improved operative skills,good myocardial protection,stable perfusion,appropriate treatment of tricuspid valve lesions and the preservation of thestructures below mitral valves.