巨大左心室瓣膜置换术外科治疗经验.docVIP

巨大左心室瓣膜置换术外科治疗经验 　 作者：罗凡砚 蒋海河 林国强 雷凯波 【摘要】 目的 总结合并巨大左心室的心脏瓣膜置换术的外科治疗经验。方法 1998年7月至2007年4月51例合并巨大左心室的心脏瓣膜病人实施换瓣术。其中主动脉瓣置换术34例，双瓣置换术17例；同时行左房折叠术12例，三尖瓣成形术17例。结果 术后早期死亡8例（占15.7%），晚期死亡6例（占11.8%）。影响瓣膜置换术早期疗效及导致死亡的主要因素是术前严重左室扩大，舒张末直径(LVEDD)＞8.5cm；严重左室收缩功能下降，射血分数(EF)＜0.40；术后恶性心律失常和严重低心排以及多脏器功能衰竭；术后室颤和术前严重左室扩大伴收缩功能下降也是导致晚期死亡的主要原因。结论 对心脏左室功能的正确评估、手术适应证和时机的选择、围术期的正确处理是治疗关键。 【关键词】 巨大左心室 瓣膜置换 　　【Abstract】 Objective To summarize the experience of valve replacement operation for the patients with giant left ventricle．Methods 51 patients with giant left ventricle underwent valve replacement operation in our hospital from July 1998 to April 2004 were analyzed retrospectively．Aortic valve replacement(AVR)in 34, combined mitral and aortic valve replacement was performed in 17， left atrium placation surgery in 12，tricuspid valve annuloplasty in 17．Result The early postoperative mortality rate was 15.7％ .The late mortality rate was 11.8％.The main factors influencing the early surgical results were preoperative severe left ventricular enlargement(LVEDD≥8.5 cm), and systolic dysfunction(EF≤0.40), postoperative ventricular fibrillation and postoperative low cardiac output and multiple organ failure．The main factors affecting long-term survival were postoperative severe ventricular arrhythmia and left ventricular enlargement with depressed systolic performance. Conclusions The keys to improve the early and late results of multiple valve in these patients with giant left ventricle are the choice of optimum surgical timing, the proper management of the high risk factors mentioned above during perioperative periods. 　　【Key Words】 Giant left ventricle Valve replacement 巨大左心室是影响心脏瓣膜手术疗效的高危因素［１，２］。作者分析本院自1998年7月至2007年4月为51例合并巨大左心室行瓣膜置换术病人的临床资料，着重探讨影响病人手术效果的高危因素、手术适应证和时机选择、围术期处理，并探讨近、远期手术疗效。 　　1 临床资料 　　1.1 一般资料 　　全组共51例，男43例，女8例；年龄16～58岁，平均40.2岁。病变为风湿性心脏病38例、退行性变5例、先天性心脏病5例、细菌性心内膜炎3例。瓣膜病变性质为单纯主动脉瓣关闭不全26例、主动脉瓣狭窄并关闭不全8例、合并二尖瓣病变者17例，同时合并有三尖瓣关闭不全者17例。术前NYHA心功能分级为III级40例、IV级11例。术前超声心动图检查舒张末直径(LVEDD)