138例巨大左心室患者瓣膜置换术的临床分析  

Heart valve replacement for giant left ventricle: Clinical analysis of 138 cases

作　　者：罗立国[1] 景华[1] 胡小南[1] 李德闽[1] 李忠东[1] 

机构地区：[1]南京军区南京总医院心胸外科,江苏南京210002

出　　处：《医学研究生学报》2009年第4期397-401,共5页Journal of Medical Postgraduates

基　　金：南京军区南京总医院重点课题基金资助项目(批准号:2003086)

摘　　要：目的：巨大左心室是影响心脏瓣膜手术效果的主要危险因素之一,总结巨大左心室（左心室舒张末内径≥7.0 cm）瓣膜置换术的外科治疗经验,以提搞疗效。方法：回顾性分析1996年6月至2008年4月138例巨大左心室患者瓣膜置换术的临床资料,术前左心室舒张末期内径（LVEDD）7.38-10.51 cm,平均（7.98±0.39）cm;左心室收缩末期内径（LVESD）5.20-7.93 cm,平均（5.88±1.03）cm;左心室射血分数（LVEF）0.21-0.66,平均0.43±0.11;左心室短轴缩短率（LVFS）0.10~0.45,平均0.25±0.07。NYHA心功能分级为Ⅲ级89例、Ⅳ级49例。单行二尖瓣置换（MVR）57例,单行主动脉瓣置换（AVR）26例,二尖瓣及主动脉瓣双瓣膜置换（DVR）40例,Bentall术15例,同期行三尖瓣成形术（TVP）78例。单瓣或双瓣置换的同时行部分左心室减容术（PLV）17例（均为LVEDD≥8.5 cm,LVEF≤25%者）。结果：术后早期死亡8例,手术死亡率5.8%;死亡主要原因为多脏器功能衰竭、严重低心排量综合征和恶性心律失常。术后超声心动图复查LVEDD、LVESD、LVEF、LVFS,与术前结果对比,术后2周LVEDD、LVESD即较术前缩小;LVEF、LVFS术后半年明显改善;17例同期行PLV患者术后2周LVEDD、LVESD较术前明显缩小,LVEF、LVFS均较术前明显改善。结论：采用含血心脏停搏液间断或持续灌注保护心肌,尽可能保留二尖瓣后瓣及其瓣下结构,尽量缩短主动脉阻断时间,围手术期以预防为主的抗心律失常治疗是提高巨大左心室瓣膜置换术疗效的关键。重症瓣膜患者瓣膜置换同期行PLV术的早期疗效满意,远期疗效仍需观察。Objective： Giant left ventricle is one of the important dangerous factors impacting the results of valve replacement operation.In order to improve the efficiency of operation,we summarized our experience in valve replacement surgery for patients with giant left ventricle（LVEDD ≥ 7.0 cm）.Methods： We retrospectively analyzed the clinical data of 138 cases of giant left ventricle treated by valve replacement operation in our hospital from June 1996 to April 2008.The preoperative left ventricular end diastolic dimension（LVEDD）,left ventricle end systolic dimension（LVESD）,left ventricular ejection fraction（LVEF） and left ventricular fractional shortening（LVFS） were 7.38-10.51 cm（mean 7.98±0.39）,5.20-7.93（mean 5.88 ± 1.03）,0.21-0.66（mean 0.43 ± 0.11） and 0.10-0.45（mean 0.25 ± 0.07）,respectively.Eighty-nine of the patients had the heart function（NYHA） of class Ⅲ,and the other 49 class Ⅳ.Mitral valve replacement（MVR） was performed for 57 cases,aortic valve replacement（AVR） for 26,double valves replacement（DVR） for 40,and Bentall operation for the other 15.Meanwhile,78 of them underwent tricuspid valve plasty（TVP）,and another 17（LVEDD ≥8.5 cm and LVEF ≤ 25%） partial left ventriculectomy（PLV）.Results： The early postoperative mortality rate was 5.8%,mainly due to postoperative multiple organ failure,severe low cardiac output syndrome and ventricular fibrillation.Compared with the preoperative data,postoperative echocardiography showed that LVEDD and LVESD were decreased slowly at 2 weeks,and LVEF and LVFS significantly improved at 6 months.In the 17 patients who underwent PLV,LVEDD and LVESD were significantly reduced at 2 weeks,and LVEF and LVFS markedly improved.Conclusion：The key to the efficiency of valve replacement for giant left ventricle was proper choice of the blood containing stop-beating fluid during the operation,preserving the posterior valve of the mitral valve and the structure beneath it,shortening aortic cross-clamping ti

关 键 词：巨大左心室 心脏瓣膜置换 部分左心室减容术 

分 类 号：R654.2[医药卫生—外科学]