巨大左心室心脏瓣膜置换术25例临床分析

目的总结巨大左心室心脏瓣膜置换术围术期的治疗方法及经验。方法25例巨大左心室病例，其中先天性心脏瓣膜病6例，风湿性心脏瓣膜病19例。心功能分级（NYHA）II级12例，III级9例，IV级4例。左心室舒张期末内径（LVEDD）70～85mm，平均74．3mm，射血分数（EF）36％～67％，均接受体外循环心脏瓣膜置换术。结果本组术后均使用多巴胺、多巴酚丁胺，8例加用肾上腺素。发生低心排血综合征（LCOS）8例，发生室颤1例，胸骨哆裂行二次清创缝合1例，均心功能Ⅱ级出院。全组病例无死亡。结论巨大左心室病例行心脏瓣膜置换术，充分的术前治疗、术中加强心肌保护、置换适当型号瓣膜、保留瓣下结构、术后加强心功能监测与治疗等方面，均应充分重视。

Clinical Analysis of Cardiac Valve Replacement in 25 Cases with Giant Left Ventricle

Objective To summarize the treatment and experiences of cardiac valve replacement in patients with giant left ventricle in the perioperative period. Methods Out of the 25 cases with giant left ventricle, 6 cases were with congenital valve disease and 19 cases were with rheumatic valve disease; there were 12 cases of NYHA II, 9 cases ofNYHA III and 4 cases of NYHA IV; left ventricular end-diastolic diameters （LVEDD） were from 70mm to 85mm with the average of 74.3mm, the ejection fractions （EF） were from 36% to 67%; all the patients underwent cardiac valve replacement under cardiopulmonary bypass. Results Dopamine and dobutamine were administrated to all the patients after operation, and epinephrine was added to 8 cases; low cardiac output syndrome occurred in 8 cases, ventricular fibrillation in 1 case; a second debridement-and-suturing was performed on 1 cases with multi-opening wound in sternum; all the patients discharged with heart function class II , no death occurred. Conclusions More attention should be paid to fully preparation before operation, the protection of myocardium in operation, the selection of proper type of valves, the preservation of sub-valve structure, the careful monitoring of heart function and treatment after operation in patients with giant left ventricle who are to undergo cardiac valve replacement.