重症心脏瓣膜病合并巨大左心室的外科治疗

目的　总结心脏瓣膜病合并巨大左心室外科治疗经验。方法　对 34例巨大左心室心脏瓣膜病人 (L VEDD>70 mm,L VESD>5 0 m m,EF<0 .5 ,FS<0 .2 5 )施行心脏瓣膜替换术。心肌保护方法分别采用冷晶体停搏液灌注 ;温氧合血持续灌注和心脏不停搏心内直视手术。瓣膜缝合采用连续缝合。结果　本组治愈 32例 ,早期死亡 2例 ,术后C/ T、L VEDD较术前明显改善 (P<0 .0 1) ;L VESD、L VESVI也较术前改善 (P<0 .0 5 )。 L VEF、L VFS与术前比较无显著差异 (P>0 .0 5 )。随访 6个月～ 7年 ,晚期死亡 2例。心功能恢复 级者 2 1例 , 级者 8例 , 级者 1例。结论　巨大左心室心脏瓣膜病人经充分的术前准备后仍应考虑手术治疗 ,选择良好的手术时机对手术的成败具有重要意义 ;温氧合血持续灌注和心脏不停搏技术的应用及保留二尖瓣瓣叶及瓣下结构对提高手术成功率有一定帮助 ;合理的围术期处理是手术成功的重要一环。

Surgical treatment of cardiac valvular disease combined with large left ventricle

Objective To sumarize the clinical experience in the surgical treatment of cardiac valvular disease with giant left ventricle. Methods 34 patients suffered from cardiac valvular disease with giant left ventricle (LVEDD>70mm,LVESD>50mm,EF< 0.5,FS<0.25) were undergone valve replacement, useing cold crystalloid cardioplegia or warm diluted oxygenated blood cardioplegia for myocardial protection during open heart surgery under heart-beating with shallow hypothermia. Relults 32 patients were cured by valve replacement.2 cases dead in early period after operation. Compared with the preoperation,C/T and LVEDD were improved(P<0.01),and LVESD and LVESVI were improved as well (P<0.05).LVEF and LVFS did not change significantly.Followed up for 6 months to 7 years,2 patients dead in late period after valve replacement. Heart function(NYHA class) improved 1 grade in 21 patients,2 grade in 8 patients and 3 grade in 1 patient. Conclution An optimal operative opportunity and adequate preoperation preparation are key points for the successful treatment of cardiac valvular disease with giant left ventricle. It is may helpful to use the technique of warm diluted oxygenated blood cardioplegia perfution or under heart-beating and preserve mitral leaflets with subvalvular apparatus for decreasing the low cardiac output syndrome and motality at early period after operation. Also it is important to have a reasonable treatment at perioperational period.