左房顶—房隔径路二尖瓣手术与心律失常  

The experience in mitral valve operation through transseptal-left atrial dome approach and analysis of postoperative cardiac rhythms

作　　者：马旺扣[1] 刘志勇[1] 陈凡[1] 杨丹宁[1] 吴熹[1] 周玉篇[1] 

机构地区：[1]南京铁道医学院附属医院胸心外科,210009

出　　处：《中华胸心血管外科杂志》1999年第5期269-271,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的：验证左房顶—房隔径路二尖瓣手术的安全性。方法：１９９３ 年１０ 月至１９９７ 年１２ 月，采用此径路行二尖瓣手术５１ 例，其中二尖瓣替换术（ＭＶＲ）１８ 例，二尖瓣成形术（ＭＶＰ）１ 例，二尖瓣及主动脉瓣替换术（ＤＶＲ）３２ 例。结果：早期死亡２ 例（３ ．９ ％ ） ，余４９ 例随访２ ～４８ 个月。术前为窦性心律者１２例，术后早期２ 例发生房颤，４ 例窦性心动过缓，出院时均恢复正常窦性心律；术前为房颤心律者３７ 例，随访中９ 例（２３ ．４ ％ ） 转为窦性心律并长期维持。所有术后窦性心律者，窦房结对运动反应正常。结论：本径路对各种二尖瓣手术显露优于既往所用传统径路。虽术期心律失常发生率稍高，但后期结果均良好。未发生与本径路有关的死亡和并发症。因此，是优良而安全的。Aim:Transseptal-left atrial dome approach provides an excellent field in mitral valve operation.Because it may require division of the sinus node artery in most cases the safety of this approach is controversial.Methods:From October 1993 to December 1997,this approach had been used and its effect on postoperative cardiac rhythms was analyzed for 51 consecutive patients who underwent mitral valve replacement(18 cases),mitral valvuloplasty(1 case) and aortic plus mitral valve replacement(32 cases).Results:All patients were followed up from 2 to 48 moths.There were 2 early deaths postoperatively(3.9%).Among the 12 patients with sinus rhythm preoperatively.2 patients had transient atrial fibrillation and 4 patients had sinus bradycardia postoperatively.Among 37 patients with atrial fibrillation before operation,9 of them recovered to sinus rhythm and persisted permanently during late follow-up.All those with sinus rhythms the sinoatrial node responded normally to exercises.Conclusion:Although the incidence of dysrhythmia was a little high with the transseptal-left atrial dome approach in the early postoperative period,it is reversible.This approach could provide a good access to the mitral valve.

关 键 词：二尖瓣替换术 心律失常 安全性 

分 类 号：R654.2[医药卫生—外科学] R541.7[医药卫生—临床医学]