二尖瓣置换术并发左室破裂的原因及对策  

Cause and management of left ventricular rupture following mitral valve replacement

作　　者：戚晓通[1] 陈亦江[1] 吴延虎[1] 张石江[1] 

机构地区：[1]南京医科大学第一附属医院胸心外科,210029

出　　处：《江苏医药》2011年第15期1786-1789,共4页Jiangsu Medical Journal

摘　　要：目的探讨二尖瓣置换术并发左室破裂的原因及对策。方法回顾性分析二尖瓣置换术并发左室破裂10例临床资料。4例为单纯二尖瓣置换术,2例同时行主动脉瓣置换术,3例同时行三尖瓣成形术,1例同时行冠状动脉旁路移植术。其中的8例为早期破裂,2例为延迟破裂。左室破裂原因为风湿活动控制不好、心肌脆弱或手术操作不当,如牵拉剪除乳头肌过多,清除钙化过深。9例摘除原置换瓣膜行修补手术。8例Ⅰ型破裂采用心内心外同时修补;2例Ⅲ型破裂,1例采取心内心外同时修补,另1例采取心外修补的方法。结果 1例Ⅲ型破裂患者存活,其余9例均死亡。9例死亡病例均死于手术无法修补破口。结论对可能发生左室破裂的高危患者术前应正规抗风湿治疗,术中积极预防、避免意外损伤,术后有效控制血压波动;一旦发生左室破裂,应早期诊断、尽早再次手术修补。Objective To summarize the cause and management of left ventricular rupture（LVR） following mitral valve replacement（MVR）.Methods Data of ten LVR cases following MVR were retrospectively analyzed,of whom 4 cases underwent MVR alone,2 cases MVR plus aortic valve replacement（AVR）,3 cases MVR plus tricuspid surgery,and one case MVR plus coronary artery bypass grafting（CABG）.Eight patients had an early rupture and two patients had a delayed rupture.The causes of rupture included uncontrollable rheumatic fever,fragile myocardium and inappropriate procedure such as overexcision of calcification or stretch of papillary muscle.Urgent repair of the rupture was performed under cardiopulmonary bypass in all cases,in whom the mitral prostheses were taken out in nine cases.Eight patients were type I rupture and the ruptures were repired via internal and external approa.Of 2 cases with type Ⅲ rupture,one was repired via internal and external approaches,and the other via external approach.Results Only one patient with type III rupture was survival.The others were all died of uncontrollable intraoperative bleeding.Conclusion In the patients with high risk for LVR after MVR,attention should be paid to taking effective treatment of rheumatic fever before surgery,avoiding surgical injury during operation,diagnosing early and repairing successfully.

关 键 词：二尖瓣置换术 左室破裂 

分 类 号：R619[医药卫生—外科学]