心脏瓣膜病巨大左心室病人的瓣膜置换

目的：探讨瓣膜病巨大左心室病人的临床特点，及影响手术疗效的主要因素，提高瓣膜置换术后的疗效。方法：共47例瓣膜病巨大左心室病人行瓣膜置换术，其中主动脉与二尖瓣双瓣置换35例，二尖瓣置换5例，主动脉置换7例，同时行三尖瓣成形42例，左房折叠4例。结果：术后早期并发症14例(349／6)，死亡2例(4．259／6)，影响瓣膜置换手术早期疗效的主要因素是严重左室扩大，严重左室收缩功能下降，射血分数(EF)＜0．40，左室短轴缩短率(FS)＜0．25和严重低心输出量综合征，和围术期室颤。结论：掌握合适手术时机，注意心肌保护措施，最大限度地保留心内结构是巨大左心室病人瓣膜置换手术成功的重要因素。

Valve replacement of valvular heart disease with giant left ventricle

Objective:To study the clinic pathologic characteristics of valvular heart disease with giant left ventricle and the influential factors on the operative results so as to improve the result of valve replacement operation. Methods:Multiple valvular operations were performed in 47 patients with giant left ventricle, combined mitral and aortic valve replacement was performed in 35,mitral valve replacement in 5,aortic valve replacement in 7, and tricuspid valve annuloplasty in 42,left atrium placation surgery in 4 . Results:The early complication and mortality rate were 34% and 4.25%,respectively. The mainfactors influencing the early surgical results were preoperative severe left ventricular enlargement and systolic dysfunction, EF<0.40,FS< 0.25 and postoperative low cardiac output, perioperative ventricular fibrillation. Conclusions:The keys to improve the early results of multiple valve replacement in the patients with giant left ventricle are the choice of optimum surgical timing,technique of myocardial protection and preservation of valve and subvalvular apparatus.