摘要
目的 总结合并巨大左心室瓣膜病行心脏瓣膜置换术的疗效 ,探讨影响手术疗效的主要因素及手术适应证选择。方法 1991年 5月至 2 0 0 2年 7月共为 6 2例瓣膜病合并巨大左心室病人施行了心脏瓣膜置换术 ,其中主动脉瓣与二尖瓣双瓣置换术 5 6例 ,二尖瓣置换术 5例 ,主动脉瓣置换加三尖瓣成形术 1例 ;同时行三尖瓣成形术 4 3例 ,左房折叠术 12例。结果 术后早期并发症 2 8例 (4 5 2 % )。早期死亡11例 (占 17 7% ) ,晚期死亡 4例 (6 5 % )。影响瓣膜置换术早期疗效的主要因素是术前严重左室扩大 [收缩末直径 (ESD)≥ 6 0cm和舒张末直径 (EDD)≥ 8 0cm]、严重左室收缩功能下降、射血分数 (EF)≤ 0 4 0和短轴缩短率 (FS)≤ 0 2 5 ,围术期室颤和术后严重低心输出量综合征以及多脏器功能衰竭 ;影响远期疗效的主要因素是室颤和术前严重左室扩大伴收缩功能下降。结论 提高此类病人手术疗效的关键是选择合适手术时机 ,妥善处理围术期和术后高危因素。
Objective: To summarize the experience of valve replacement for multiple valve insufficiency in patients with giant left ventricle and the operative indication. Methods: Multiple valvular operations were performed in 62 patients with giant left ventricle between 1991 and 2002. Combined mitral and aortic valve replacement was performed in 56, tricuspid valve annuloplasty in 43, left atrium placation surgery in 12, and mitral valve replacement in 5. Results: The early postoperative complication and mortality rate were 45.2% and 17.7%, respectively .The late mortality rate was 6.5%. The main factors influencing the early surgical results were preoperative severe left ventricular enlargement (ESD ≥6.0cmand EDD ≥8.0cm) and systolic dysfunction (EF ≤0 40 and FS ≤0 25), perioperative ventricular fibrillation, postoperative low cardiac output and multiple organal failure. The main factors affecting long term survival were postoperative severe ventricular arrhythmia and left ventricular enlargement with depressed systolic performance. Conclusion: The keys to improve the early and late results of multiple valve replacement 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 and follow up periods.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2003年第4期203-205,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
