单纯主动脉瓣关闭不全合并巨大左心室患者的手术疗效分析

目的 评价单纯主动脉瓣关闭不全合并巨大左心室患者主动脉瓣置换术后的近、中期手术结果.方法 从1999年12月至2006年1月阜外心血管病医院共收治单纯主动脉瓣关闭不全合并巨大左心室患者31例,左心室舒张末径≥80 mm.全部进行主动脉瓣置换,并对患者进行随访,对比术前、术后早期(术后1个月内)、随访超声结果.按照心功能是否正常、左心室舒张末内径的大小进行分组比较术后风险因素.结果 近期死亡1例,随访期间死亡3例.术后早期左心室舒张末内径为(69±11)mm,与术前的(86 ±8)mm相比,有明显回缩(P=0.001),但心功能尚无明显改善.随访期问,无论心射血分数(58 ±15),还是左心室大小(55±10)mm]均较术前分别为44±11,(86±8)mm]有明显改善(均P=0.001),趋于正常化.术前心功能状况、左心室大小并未影响手术中期死亡和左心室功能.结论 单纯主动脉瓣关闭不全合并巨大左心室患者仍有手术指征,绝大多数患者可以延长寿命、提高生活质量.

Mid-term results of surgical treatment for aortic regurgitation with large left ventricle

OBJECTIVE: To evaluate the recent and mid-term results of aortic valve replacement for aortic valve insufficiency with large left ventricle. METHODS: From Dec 1999 to Jan 2006, 31 patients with aorta insufficiency with the left ventricle larger than 80 mm, 30 males and 1 female, aged (36 -/+ 11), underwent aortic valve replacement and were followed up after discharge by mail and/or telephone call for (46 +/- 23) months (3-85 months), and followed up by ultrasonography for (25 +/- 24) months (3-70 months). The ultrasound cardiographic data were analyzed. Groups were divided according to heart function and LVED to analyze risk factors after operation. RESULTS: One case died before discharge from the hospital and 3 cases died during the follow-up. The left ventricular end-diastolic diameter (LVEDD) after operation was (69 +/- 11) mm, significantly smaller than that before operation (86 +/- 8) mm, P = 0.001]. The LVEDD continued to decrease during the follow-up and became (55 +/- 10) mm. The ejection fraction early during the follow-up was (58 +/- 15), significantly higher than that before operation (48 +/- 13)%, P = 0.001]. The heart function and LVEDD before operation had little effects on the long term mortality and left ventricle function. Conclusion The patients with aortic valve insufficiency and large left ventricle still have indication for surgical treatment and most of such patients have good results in mid-term follow-up.