二尖瓣置换术后生物瓣瓣膜毁损的定义及再手术时机探讨

目的探讨二尖瓣置换术后生物瓣毁损的定义及再手术时机。方法对５５例患者施行牦牛心包瓣膜置换二尖瓣手术。术后随访至１９９３年９月，累积随访３７９．４患者／年，平均６．９年。结果瓣膜毁损１６例，轻度病例１年后仅１６．７％（２／１２）转变为重度；再手术５例，术后４例康复，１例死于呼吸衰竭。结论瓣膜毁损可分为轻度和重度。轻度为瓣膜钙化；重度指瓣膜穿孔或撕裂，瓣膜中度以上狭窄或返流。轻度毁损宜观察，重度毁损则应及时手术。

Discussion on the Definition of Bioprosthetic Valve Deterioration and Adequate Time for Reoperation after Mitral Valve Replacement

Objective The definition of bioprosthetic valve deterioration and appropriate time for reoperation after mitral valve replacement are discussed. Methods Patients received jak pericardial bioprostheses were followed up periodical by clinical examination and ultrasonography. 55 cases had been followed up to sept 1993 since 1985. The follow up totaled 379.4 patient years ,mean 6.9 years. When infection was excluded bioprosthetic valve deterioration was defined as: (1) Valve calcification, perforation, or disruption; (2) Moderate or severe valve stenosis or regurgitation. Results There were 16 cases of bioprosthetic valve deterioration, the rate of converting mild deterioration into severe deterioration was only 16.7% (2/12) after one year. Of the 5 reoperated patients 4 recovered and 1 died from resporetory failure. Conclusion The bioprosthetic valve deterioration could be further divided into the mild and the severe deteriovations. The mild one means that the patient has no symptom but echocardiogram shows valve calcification. The severe case means valve perforation disruption; or moderate to severe valve stenosis or regurgitation. The mild case should be observed first and reoperation would be performed only when the bioprosthetic valve deterioration worsened, however, for the severe case discoverd immediate reoperation is necessary.