重症心脏瓣膜病外科治疗

目的探讨危重心脏瓣膜病外科治疗效果，以期提高存活率。方法对危重心脏瓣膜病患者100例给予手术治疗。术前心功能Ⅲ级60例，Ⅳ级40例。结果共死亡4例（4％），死于术后低心排综合征1例，突发室颤抢救无效死亡3例，其96例顺利出院；心功能恢复至Ⅰ级10例、Ⅱ级29例、Ⅲ级14例。术后心胸比率有不同程度缩小；瓣膜病变超声心动图检出情况：主动脉瓣钙化或硬化12例（40．0％），二尖瓣硬化与钙化13例（26％）；术后20个月左室舒张末期内径（LVEDD）（53．0±7．0）mm低于出院时（64．0±6．2）mm（t=3．789，P〈0．05）；术后20个月左室射血分数（LVEF）为（42．5±11．0）％，高于出院时（37．5±6．2）％，（t=3．799，P〈0．05）。结论对重症心脏瓣膜病患者，注重改善术前心功能，尽量保留瓣下组织，加强术后并发症的防治，可提高术后存活率。

Analysis of surgical treatment of severe valvular heart disease

Objective To investigate the effects of surgical treatment of severe valvular heart disease to improve early survival. Methods 100 cases with severe heart valve surgery were opercted,The mitralvalve replacement (MVR) in 50 cases, aortic valve replacement (AVR) in 30 cases, MVR + AVR in 20 cases;tricuspid valvuloplasty (TVP) in 50 cases,dissection of left atrial thrombus in 25 cases,left atrial plication in 12 cases,coronary artery bypass grafting(CABG) in 20 patients; The Ⅲ grade of heart function( n = 60), Ⅳ grade( n = 40). Results A total of 4 cases died(4％ )died of postoperative low cardiac output syndrome in 1 case, sudden ventricular fibrillation in 3 cases died,the other 96 cases discharged;heart function recovered to 10 cases of grade Ⅰ, Ⅱ Grade 29 cases, Ⅲ grade 14 cases. Postoperative cardiothoracic ratio reduced to varying degrees;The 12 cases(40％ ) with aortic valve calcification or hardening,13 cases(26％ ) with mitral valve sclerosis or calcification in patients with severe valvular heart disease by echocardiography; The left ventricular end-diastolic diameter(LVEDD) (53 ± 7.0) mm after 20 months were lower than the discharge ( 64.0 ± 6.2) mm( t = 3.789, P ＜ 0.05 ) ; The left ventricular ejection fraction (LVEF)after 20 months(42.5 ±11.0)％were highter than that at discharge(37.5 +6.2)％ ,(t =3.799,P ＜0.05). Conclusion Improving heart function, keeping the flap tissue to enhance prevention of postoperative complications, could significandy improve the results of valve replacement for the patients with severe valvular heart disease.