主动脉瓣置换术127例临床分析

目的总结主动脉瓣人工机械瓣替换术的临床经验。方法对主动脉瓣机械瓣替换手术127例进行临床分析，年龄13—76岁，平均54．5岁，60岁以上38例。风湿性心脏病64例，先天性瓣叶畸形28例，退行性病变14例，感染性心内膜炎（IE）18例，其中人工瓣膜感染性心内膜炎3例。单一主动脉瓣狭窄5例，主动脉瓣关闭不全76例，狭窄伴关闭不全46例。其中有主动脉窦瘤破裂3例，合并二尖瓣病变68例和（或）三尖瓣病变43例、合并升主动脉瘤样扩张或主动脉夹层8例、冠心痛2例、陈旧性脑血管意外6例，室间隔缺损3例、房间隔缺损3例。心功能Ⅲ级82例，Ⅳ级45例。术前术后心脏超声指标进行对比（LVED、LVEDV、跨瓣压差、LVEF、LVEFS）。结果心超提示：LVED、LVEDV、跨瓣压差较术前明显减少，LVEF、LVEFS明显升高，差异有统计学意义，提示主动脉瓣机械瓣替换术后心功能近期明显改善，中期效果更好。平均随访36个月。结论主动脉瓣机械瓣替换术后心功能较术前明显改善，生活质量明显提高，随着手术技术、心肌保护技术、围术期处理的提高、心肌缺血再血管化手术及对伴发心脏其它疾病的正确处理，手术并发症和病死率明显下降。

Clinical Analysis of Aortic Valve Replacement:a Report of 127 Cases

Objective The clinical experience of aortic valve replacement （AVR） were summarized. Methods AVR were performed in 127 patients,their average age was （54.5 ± 13.2,13 to 76） years old,38 cases of the patients were over 60. The etiology were rheumatic （ 50.5 % ）, congenital（ 19.7% ）, degenerative （ 11.1% ）, infective endocarditis （ including 3 cases of pros-thetic valve endocarditis, 13.4% ）. There were 5 cases of aortic stenosis ,76 cases of aortic insufficiency ,46 cases of aortic stenosis with insufficiency. 3 cases were combined with rupture of aortic sinus aneurysm,68 cases with mitral valve disease and 43 cases with tricuspid valve disease ,8 cases with ascending aortic aneurysm or dissection ,2 cases with coronary artery diseases ,6 cases with old cerebrovascular accident,3 cases with ventricular septal defect and 3 cases with atrial septal defect. The cardiac function of 82 patients was in class Ⅲ （NYHA） and 45 was in class Ⅳ, respectively. The left ventricular end diastolic diameter （LVEDD） ,left ventricular end diastolic volume （LVEDV）, aortic valve pressure gradient and left ventricular ejection fractions （LVEFs） were determined and compared before and after the operations. Results After the operation,aortic pressure gradient, LVED and LVEDV decreased obviously, while the LVEF increased markedly, the difference had statistically significance （ P 〈 0. 05 or P 〈 0.01 ）. The follow up of average 36 months showed that the heart function was improved obviously after the AVR operations. Conclusion The cardiac function and life quality of the patients were improved excellently by AVR. The operative complications and mortality rate from AVR may be decreased significantly with the improvement of surgical technique, myocardial pro- tection, perioperative managements.