风心病并发脑栓塞病人的瓣膜替换术

报告６４例风心病并发脑栓塞病人的瓣膜替换术。术前心功能Ｉ级１０例、ＩＩ级３８例、ＩＶ级１６例。伴房颤者５４例。脑栓塞史半年以上者４４例，６个月以内２０例，其中２个月以内者１４例。３４例有程度不同的脑栓塞后遗症。行二尖瓣替换术４７例、双瓣膜替换术１７例，同期行三尖瓣环环缩或成形术４３例。术中证实有左房血栓２５例（３９％）。手术死亡率６．２５％。术后并发颅内出血和栓塞各１例。结果表明风心病并发脑栓塞病人的手术效果良好。作者指出，脑栓塞２个月以上者应尽早手术，２个月以内者则应根据脑栓塞程度、恢复情况及有无左房血栓，选择手术时机。并介绍了围术期的处理经验。

Valve Replacement in Patients with Rheumatic Valvular Disease and Cerebral Thromboembolic Episodes

Aim:To review the experience of valve replacement in patients with rheumatic heart disease and cerebral thromboembolic episodes(CEE).Method:64 patients with rheumatic valvular disease and CEE were included in this study.Preoperative heart function was class II in 10 patients,class III in 38 and class lV in 16.Atrial fibrillation was presented in 54 patients.Forty-four patients had history of CEE more than 6 months and 21 less than 6 months.Thirty-four patients had various degrees of complications resulted from CEE.Mitral replacement was performed in 47 patients,double valve replacement in 17,and tricupid valve repair in 43.Left atrial thrombosis was found in 25 patients. Result:The hospital mortality was 6.25%.Postoperative complications included cerebral hemorrhage in 1 and thromboembolism in 1.All survivals had good surgical outcome.Conclusion:The timing of operation is a very important factor influencing surgical outcome.For patients with history of CEE more than 2 months,surgery should be employed as earlier as possible,however,for those with CEE less than 2 months,the timing of operation depends on the severity of CEE,condition recovery of and presence of left atrial thrombus.