风湿性心脏病并发缩窄性心包炎的外科治疗

目的:总结风湿性心脏病并发缩窄性心包炎患者施行瓣膜置换及心包剥除术外科治疗经验。方法:回顾性分析1992-06-2010-02期间对13例风湿性心脏病并发缩窄性心包炎患者施行瓣膜置换及心包剥除术的临床资料。结果:术后死亡1例,死亡原因为重度低心排血量,病死率7.69%。术后不同程度低心排血量6例,术后再次开胸止血1例。13例心包病理检查均为风湿性。随访3个月～8年,心功能Ⅰ～Ⅱ级10例,Ⅲ级2例。结论:对风湿性心脏病并发缩窄性心包炎患者,同期行瓣膜置换和心包剥除手术,积极有效的围术期处理能达到理想的治疗效果。

Surgical treatment of constrictive pericarditis complicated by rheumatic heart disease

Objective:To review our experience of surgical treatment on valve replacement and pericardiectomy for patients with rheumatic heart disease and constrictive pericarditis.Method:Clinical data of 13 cases with rheumatic valvulitis and constrictive pericarditis treated with valve replacement and pericardiectomy from June 1992 to February 2010 were retrospectively analyzed.Result:One post-operative patient died of severe low cardiac output(mortality=7.69%),6 had low cardiac output at various levels,and 1 was given surgical hemostasis via thoracotomy.Among all the pathologic pictures of pericarditis,13 patients with pericardial disease were rheumatic.New York Heart Association class was Ⅰ-Ⅱ in 10 patients and Ⅲ in 2 patients after 3 months to 8 years’ follow up.Conclusion:Concomitant valve replacement and pericardiectomy with intensive peri-operative monitoring and management contributed to the excellent improvements in patients with rheumatic heart disease constrictive pericarditis.