右胸小切口不阻断升主动脉和腔静脉心脏跳动下二尖瓣置换术

目的探讨右胸小切口不阻断升主动脉和腔静脉在心脏跳动下二尖瓣置换术的可行性。方法2009年4月至2010年3月，11例患者经右胸前外侧小切口（6-10cm），经股动脉插管，上、下腔静脉插管建立体外循环。不阻断升主动脉和腔静脉，在心脏跳动下，经房间沟-左房切口行二尖瓣置换术。置换瓣膜均为机械二尖瓣。结果术后患者全部治愈。体外循环转机时间（52．80±11．36）min，呼吸机辅助时间（8．20±2．84）h，术后输（2．20±1．04）u浓缩红细胞。术后无神经系统并发症，复查心脏彩色多普勒超声均提示机械二尖瓣启闭良好，无机械瓣周漏。结论右胸小切口不阻断升主动脉和腔静脉，在心脏跳动下二尖瓣置换手术可行。该方法具有保持胸廓完整性、创伤小、恢复快的优势。

The technique of mitral valve replacement in beating heart without crossclamping ascending aorta and vena cava through right minithoracotomy

Objective To evaluate the technique of mitral valve replacement in beating heart without crossclamping ascending aorta and vena cava through right minithoracotomy. Methods From April 2009 to March 2010, eleven patients received right minithoracotomy, using femoral extracorporeal circulation. Mechanical mitral valve was replaced in beating heart without crossclamping ascending aorta and vena cava through left atrium. Results The operation succeeded in all five patients. The mean cardiopulmonary bypass time was （52.80±11.36） minutes, the mean mechanic ventilation assistant time was （8.20±2.84）hours, the mean transfusion volume of concentrated red cell was （2.20±1.04）units. There were no cerebral complications or periprothetic leakage by using transesophageal color Doppler echocardiography. Conclusion Mitral valve replacement in beating heart through right sabaxillary anterolateral minithoracotomy is feasible, less invasive, simple and safe.