感染性心内膜炎主动脉瓣置换手术方法探讨  

Surgical method of aortic valve replacement in the treatment of infective aortic valve endocarditis

作　　者：李宗虓 刘晓程[1] 何国伟[1] 靖文斌[1] 刘立新[1] 

机构地区：[1]泰达国际心血管病医院心外科,天津市300457

出　　处：《中国心血管病研究》2010年第4期282-283,共2页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨感染性心内膜炎主动脉瓣置换的手术方法。方法回顾分析我院手术治疗的3例感染性心内膜炎主动脉瓣病变患者的临床资料及间断全层缝合主动脉壁置换主动脉瓣的手术方法。术中均可见主动脉瓣赘生物，瓣叶裂，穿孔，主动脉瓣环水肿，主动脉内膜断裂，瓣周脓肿形成。切除病变主动脉瓣，清除坏死组织及赘生物，以碘伏涂抹主动脉根部并浸泡机械瓣膜及换瓣线，游离主动脉根部至瓣环水平，避免损伤冠状动脉，带垫片换瓣线自主动脉壁外进针，垫片置于主动脉壁外侧，16-20针间断缝合，机械瓣环上打结，置换机械瓣膜。结果3例患者术后恢复顺利，3个月至1年随诊，预后良好。结论间断全层缝合主动脉壁置换主动脉瓣方法可以预防复发感染性心内膜炎，减少瓣周漏的发生，安全、有效，远期效果良好。Objective The aim of the study was to evaluate the methods of prosthetic valve replacement in the treatment of infective aortic valve endocarditis. Methods From June 2008 to November 2009, 3 cases of aortic valve endocarditis underwent surgery of aortic valve replacement for active aortic valve endocarditis at our institution. These cases were retrospectively studied. There were aortic valve vegetations, valve cusp fiss or perforation, as well as deterioration of the aortic wall and paravalvular areas in all patients. After resecting the infective aortic valve and clearing the necrotic tissue and vegetations, the operating field and the prosthetic valve were washed with povidoneiodine solution for disinfection. Interrupted horizontal mattress sutures （16-20） with pledgets were placed outside of the aortic wall, going through the aortic wall and then placed on the prosthetic sewing ring. Results All patients recovered smoothly after operation. They were followed during 3 months to 1 year postoperatively with satisfactory life style. There was no late mortality. There was neither recurrence of endocarditis nor paravalvular leakage at the follow-up. Conclusion The method described is an effective treatment for infective aortic valve endocarditis with high survival rate, low operative mortality, and low recurrent rate of infection.

关 键 词：感染性心内膜炎 主动脉瓣置换术 

分 类 号：R654.2[医药卫生—外科学]