闭式二尖瓣扩张术后心脏瓣膜替换52例

目的:探讨闭式二尖瓣扩张术后心脏瓣膜替换术的手术指征、手术方法及并发症防治。方法:回顾分析闭式二尖瓣扩张术后心脏瓣膜替换52例,男性14例,女性38例,年龄25～69岁。术式为二尖瓣替换46例,二尖瓣+主动脉瓣替换6例,同时施行三尖瓣成形14例,左心房血栓清除8例,冠状动脉搭桥1例。结果:术后并发脑栓塞2例,其中1例死于严重脑损害;急性心包压塞1例,经及时心包引流治愈。随访3个月至16年,获访47例,晚期死亡1例,其余心功能明显改善。结论:合理选择手术适应证,术中加强心肌保护,有效预防脑栓塞和术中、术后出血是取得良好疗效的关键。

Heart valve replacement after closed mitral commissurotomy:52 cases

Objective:To discuss appropriately operative indication,method and prevention and treatment of perioperative complication.Method:Cardiac valve replacement was performed in 52 patients after closed mitral commissurotomy.It included 14 male and 38 female patients aged 25-69 years old.Mitral valve replacement was performed in 46 and both mitral and aortic in 6,associated procedures were tricuspid annuloplasty in 14,left artrium thorombectomy in 8 and coronary artery grafting in 1.Result:There were cereboembolism in 2 cases in which 1 case was death and cardiac tamponade in 1 case treated by pericatdiostomy.Follow-up 3 months to 16 years there was 1 death,and other shows substantial improvement in cardiac function.Conclusion:The choice of appropriately operative chance,myocardial presevation and prevention of cerebroembolism and hemorrhage were the keys to get an excellent result in patients performed valve replacement after closed commissurotomy.