左心房折叠术在二尖瓣病变合并巨大左心房治疗中的应用.doc

左心房折叠术在二尖瓣病变合并巨大左心房治疗中的应用 ?918?2005年7月第43卷第14期ChinJSurg,July200…5Vo1.. 左心房折叠术在二尖瓣病变合并 巨大左心房治疗中的应用 郑斯宏孙衍庆孟旭高峰黄福华 . 胸心血管外科. 【摘要】目的探讨左心房折叠术治疗二尖瓣病变合并巨大左心房的临床应用效果.方法 回顾性分析23例收缩末期左心房内径为(129±37)mm(92—250mm),行左心房折叠术的二尖瓣手 术患者的临床资料.22例选用人工机械瓣膜置换,1例为生物瓣置换,同期行左心房折叠术.术前心 功能NYHA分级,Ⅲ级15例,Ⅳ级8例;术前心胸比为0.79±0.10.单纯二尖瓣置换术18例,其中行 三尖瓣成形术1O例;双瓣膜置换和三尖瓣成形术5例,其中二次手术2例,术中行心房纤颤射频消 融术2例.结果术后低心排出量综合征3例(13%),呼吸衰竭2例(9%).早期死亡3例(13%), 其中2例为低心排出量综合征,1例为脑梗死.术后失访2例,术后1年意外死亡1例,平均随访(44 ±39)个月,17例生存患者心功能I级14例,Ⅱ级3例;术后心胸比为0.68±0.11,较术前明显缩小 (t=3.80,P=0.000).结论在瓣膜病手术的同时对巨大左心房症行左心房折叠术,可减少术后并 发症,术后效果良好. 【关键词】心脏外科手术;心脏瓣膜疾病;房颤射频消融术;治疗结果 LeftatrialplicationforleftatriumassociatedwithmitralvalvediseasezHENGs—hong.SUN Yan-qing,MENGXU,GAOFeng,HUANGFu-h媳DepartmentofCardiacSurgery.BeijingAnzhen Hospital,CapitalUniversityofMedicalSciences,e100029,China Correspondingauthor:ZhengSi-,,Email:zhengsihong1962@yahoo.Com.ca 【Abstract】ObjectiveToevaluatetheeffectsofleflatrialplication(LAP)inpatientswithgiantleft atrium(GLA)associatedwithmitralvalvedisease.MethodsTwenty.threepatientswithleftatrial diameter(LAD)over8.0amwereeurolled.仙casesunderwentvalvereplacementandLAPbetween November1993andNovember2004werestudiedretrospectively.AccordingtoNewYorkHeartAssociation (NYHA)classification,15belongedtoclassⅢ.8toclassIV.Mitralvalvereplacementswereperformedin 18patients(mechanicalvalvein17andbiologicalvalvein1),doublevaluereplacementin5.tricuspid valveplasty(TvP)in15,atrialfibrillationradiofrequencyablationin2.ResultsLowoutputsyndrome happenedin3,respiratoryfailurein2.1TheearlydeathWasin3cases(operativemortality13%).1The causesofdeathwere:heartfailurein2casesandstrodein1.LADWasdecreasedsignificantlyinpatients afteroperation.ConclusionsLAPhasconsiderablybeneftciale~ctsonimprovementofpostoperative respiratoryandcardiacfunction,reducingoperativemortality.Atrialfibrillationradiofrequencyablationis effectiveinpatientswithGLAassociatedwithvalvedisease.ItmayberecommendedforpatientswithGLA duringmitralvalvesurgery.especiallyforpatientswithLADgt;