人工瓣膜功能障碍的外科治疗

目的 总结41例人工心脏瓣膜功能障碍(PHVD)的临床特点、外科治疗方法 及围术期处理经验.方法 手术均在全麻低温体外循环下进行;1例采取股动脉插管左侧开胸,40例均经原切口,主动脉、上下腔静脉插管建立体外循环.38例行瓣膜置换术,使用机械瓣35枚(二尖瓣位23枚,主动脉瓣位11枚,三尖瓣位1枚),生物瓣6枚(二尖瓣位3枚、主动脉瓣位2枚、三尖瓣位1枚);2例行瓣膜角度矫正术;1例行异物清除术.急诊手术13例,择期手术28例.结果 全组气管插管5.1～243.0 h,平均63.3 h,中位时间15.3 h;气管切开5例.全组死亡6例,病死率14.6%,均发生于急诊手术后,死因为低心排血量综合征3例、多器官衰竭2例及恶性心律失常1例.并发症包括感染性心内膜炎、顽固性呃逆及切口感染各1例.结论 对急性PHVD,无论是生物瓣或机械瓣,均应立即进行急诊手术.对慢性PHVD亦应强调及早再次手术.

Surgical treatment for prosthetic heart valve dysfunction

Objective To review our clinical experience with 41 reoperatioas of prosthetic heart valve dysfunction be-tween October 1996 and October2008. Methods There were 16 malas and 25 females with an average age of (44.5±12.6)years. All 41 patients underwent reoperation under hypothermic cardiopulmonary bypass, including 38 heart valve replace-ments, 2 disc rotations and cut of the excessive knot in 1 case. There were 13 emergency and 28 elective procedures. Results The median time for extubation was 15.3 hours and tracheostomy was needed in 5 cases. There were 6 deaths, all of which occurred in emergency cases, with a mortality rate of 15.4%. No death occurred in patients implanted with a bioprosthetic valve previously. Postoperative complications included 1 infective endocarditis, 1 intractable hiccup and 1 wound infection. Conclusion Prosthetic heart valve dysfunction is catastrophic. Early diagnosis and reoperation is mandatory.