心脏人工机械瓣相关并发症外科治疗初步经验

目的　总结 15例心脏人工机械瓣相关并发症外科治疗初步经验。方法　本组 15例患者中 ,男 7例 ,女 8例 ,年龄 315 9岁 ,平均 (4 5 .5± 8.0 )岁。术前均明确诊断 ,人工机械瓣心内膜炎 4例 ,单纯主动脉瓣周漏 4例 ,单纯二尖瓣周漏 4例 ,单纯主动脉瓣并二尖瓣周漏 2例 ,二尖瓣栓塞 1例。肺水肿 10例 ,充血性心力衰竭 6例。再次手术距首次手术时间间隔 1个月至 72个月 ,平均 (2 1.9± 18.2 )个月。本组在全麻中度低温体外循环下行再次主动脉瓣替换术 4例 ,再次二尖瓣替换术 2例 ,主动脉瓣周漏修补术 2例 ,二尖瓣周漏修补术 5例 ,主动脉瓣和二尖瓣周漏修补术 2例。同期手术包括主动脉右心室交通残余漏修补术 1例 ,三尖瓣成形术 4例 ,主动脉瓣替换术 1例 ,冠状动脉旁路移植术 1例。结果　手术死亡 5例 (33.3% )。术后低心排、多脏器功能衰竭 (3例 )为死亡主要原因。 1例为劈胸骨时损伤主动脉大出血 ,术后深昏迷死亡 ,中毒性休克死亡 1例。存活 10例 ,随访 ,死亡 1例为再次主动脉瓣替换术后半年瓣膜栓塞 ,余 9例心功能明显改善。结论　人工机械瓣膜病外科治疗值得 ,但手术危险性较高

Preliminary Experience of Surgical Treatment in Related Complications of Mechanical Prosthesis

Objective To summarize the preliminary experience of the surgical treatment in related complications of mechanical valve prosthesis.Methods During May 1991 to Aug 2002,15 consecutive patients, male 7,female 8 aged 3159 years old with complications in mechnical valve prosthesis underwent surgical operations were studied. All of the patients were definitely diagnosed preoperatively including prosthetic valve endocarditis 4 cases,simple periprosthetic leaks in aortic valve 4,simple periprosthetic leaks in mitral valve 4,simple mitral and aortic valve periprosthetic leaks 2,prosthetic thrombosis in mitral valve 1. Pulmonary edema 10 cases and congestive heart failure 6 cases were found. The interval between initial and reoperation was 1 to 72 months. The operations were performed under hypothermic cardiopulmonary bypass including redoneaortic valve replacement (n=4),redonemitral valve replacement(n=2),aortic periprosthetic leak repair(n=2),mitral periprosthetic leak repair(n=5),mitral and aortic valve periprosthetic leaks repair(n=2). Associated defects were corrected simultaneously. Results The mortality with operation was 33.3 %(5/15). The common causes of death were lowoutput syndrome, infective endotoxic shock and aortic trauma, respectively. Ten survivors were followed up 6 to 52 months. One died from prosthetic thrombosis in valve replacement half a year postoperatively. The else 9 patients were significantly improved in cardiac function. Conclusion Reoperation in valve prosthetic complications may eventually become necessary,but it is associated with higher risk.