巨大心脏瓣膜病的外科治疗

目的 探讨巨大心脏(心胸比≥0.70)瓣膜病的临床分型与手术效果的关系。方法 在低温体外循环下进行人工机械瓣膜替换,经右心房、房间隔径路行二尖瓣替换(MVR),主动脉根部横切口进行主动脉瓣替换(AVR)。本组男18例、女42例,年龄15-64岁,平均39.42±12.71岁。其中风湿性心脏病57例,先天性心脏病3例,二尖瓣病变44例(合并主动脉瓣病变15例),Ebstein畸形1例。其中对25例合并中度以上三尖瓣关闭不全的病例进行同期三尖瓣成形术,对9例巨大左心房进行左心房折叠术,有10例部分或全部保留二尖瓣装置。结果 病历统计发现,巨大心脏各型中以左心房型发生率较高(71.7%),其次为左心室型(21.7%),全心型(5%)和右心型(1.7%)。其中手术效果以左心房型最好。手术死亡3例(5%),术后并发严重低心排血量5例,严重心律失常4例。结论 根据瓣膜病变性质以及各房、室腔扩大的程度进行分型,能较全面反映患者瓣膜病变类型,临床特征,术后早期及晚期效果,同时对手术方法的设计及围术期处理具有重要指导意义。

Surgical treatment of valve disease with giant heart

Objective To investigate the relationship between the classification of the patients with giant heart disease (CTR≥0. 70)and the surgical results. Methods Valve replacement was underwent for 60 patients (male 18, female 42, ages ranged from 15 years to 64 years, the mean age was 39. 42±2. 7 years) from Dec 1992 to Jun 2001. 57 patients were rheumatic heart diseases. 3 patients were congenital heart diseases. The mitral disease 44 cases (the mitral and aortic diseases 15), Ebstein 1 case. The 25 cases with tricuspid valve incompetence were underwent tricuspid valvuloplasty. The 9 cases with giant left atrium were underwent plication of the left atrium. The 10 cases of mitral replacement were adopted the preserved methods (partial or total preservation of popillary muscles and chordae tendineae. Results From the statistics of case history, the largest occurrence rate in giant heart is the left atrium type(71. 7%). Next is the left ventricle(21. 7%) and full heart(5%), right heart(l. 7%). And the best operation effect is the left atrium type. Hospital death was 3 case (5%). Conclusion Based on the valvular lesions, dilated degree of each atrial and ventricular chamber, We classified the patients into four types. It can reflect the conditions of the diseased valves, the clinical characteristics, and the outcomes during the early and late stages after operation. It can also offer the useful suggestions to the selection of the operative methods, and have a great clinical significance for perioperative management.