风湿性心脏病手术3个瓣膜同时置换的临床经验

目的:探讨风湿性心脏病手术中3个瓣膜同时置换的经验。方法:对4例同时置换二尖瓣、主动脉瓣和三尖瓣的病人资料进行分析。结果:术中发现4例病人均有三尖瓣环扩大和瓣叶增厚导致关闭不全,2例病人伴有交界融合导致瓣膜狭窄。1例病人接受了二尖瓣位、主动脉瓣位以及三尖瓣位生物瓣置换。另3例病人接受了二尖瓣位和主动脉瓣位机械瓣置换,以及三尖瓣位生物瓣置换。1例病人死于术后低心排。其他病人平均随访30个月(12～49个月),术后心功能I级2例,Ⅱ级1例。结论:如果三尖瓣需要置换时应使用生物瓣。尽管左侧心脏瓣膜应用机械瓣,三尖瓣位应用生物瓣仍是较好的选择。

Experience of triple-valve replacement in rheumatic heart valve disease

Objective:To explore the triple-valve replacement experience in rheumatic heart valve disease.Methods:We reviewed our experience in 4 patients who underwent combined mitral and aortic valve replacement with tricuspid valve replacement between 2007 and 2011.Results:We found tricuspid annular dilatation and leaflet thickening resulting in tricuspid regurgitation in four patients,tricuspid commissural fusion leading to tricuspid stenosis in two patients.One patient received bioprosthetic valves replacement procedures in aortic and mitral position with tricuspid position.The other three patients received mechanical valves replacement procedures in aortic and mitral position,and bioprosthetic valve in tricuspid position.One patient died after operation due to low cardiac output syndrome.The mean follow-up was 30 months(range,12 to 49 months).Post-operative heart function NYHA classification:two cases in class I,one case in class Ⅱ.Conclusion:We recommend the use of a bioprosthetic valve in tricuspid position if tricuspid valve should be replaced.Even if mechanical valves are implanted in the left side of the heart,a bioprosthetic valve may be a better choice at the tricuspid position.