风湿性二尖瓣主动脉瓣三尖瓣联合病变的外科治疗  

Surgical Treatment of Rheumatic Tricuspid Valve Disease Combined with Mitral and Aortic Valvular Disease

作　　者：臧蔚[1] 邵冲[1] 谢永明[1] 戴春雷[1] 彭勇[1] 朱家麟[1] 

机构地区：[1]江苏省苏州市立医院本部胸心外科,215002

出　　处：《中华全科医学》2011年第10期1507-1508,共2页Chinese Journal of General Practice

摘　　要：目的分析风湿性二尖瓣主动脉瓣与三尖瓣联合病变外科治疗的结果。方法对50例风湿性二尖瓣主动脉瓣与三尖瓣联合病变的患者进行手术治疗。二尖瓣与主动脉瓣均作瓣膜替换术,三尖瓣关闭不全行De Vega或Key环缩术。结果早期死亡3例(6%)。随访14～48个月,晚期死亡1例(2%),其余46例术后随诊复查人工瓣膜功能良好,左心室射血分数(LVEF)提高,心功能均提高1～2级,无瓣周漏、人工瓣膜心内膜炎及心脏血栓形成,没有因瓣膜原因而再次手术者。结论风湿性二尖瓣主动脉瓣与三尖瓣联合病变的患者常伴有肺动脉高压和体循环静脉系统淤血,引起其他重要脏器功能障碍,术前充分调整心功能,选择适当的手术时机,加强术中心肌保护,不断改进和提高手术技巧,加强围术期管理,是提高手术成功率的关键因素。Objective To evaluate the clinical outcome of surgical interventions of combined mitral,aortic and tricuspid valvular lesions with rheumatic etiology.Methods fifty patients with combined mitral,aortic and tricuspid valvular lesions were performed in all patients.De Vega or Kay annulopasty was carried out in patients with functional tricuspid regurgitation.Results There were three really operative deaths with a mortality rate of 6%.During follow-up period（14-48 month）,there was one late death（2%）.46 cases had good heart valve prosthesis function,higher left ventricular ejection fraction and improved heart function classified as grade Ⅰ or Ⅱ（NYHA classification）.There were no periprosthetic leakage,prosthetic valve endocarditis and cardiac thrombosis.There were no more operations attributed to prosthetic valves.Conclusion The patients with combined mitral,aortic and tricuspid valvular lesions were often associated with pulmonary hypertension and systemic venous stasis which further led to dysfunction of the other vital organs,the well-adjusted preoperative heart function,appropriate selection of surgical opportunity,enhanced protection of intra-operative myocardium,continuous improvement of surgical techniques and reinforced peri-operative management were the contributing factors in the successful surgery of heart valve disease.

关 键 词：三尖瓣联合病变 外科治疗 

分 类 号：R542.5[医药卫生—心血管疾病]