心脏瓣膜再次替换28例报告  

Reoperation on prosthetic heart valve:a report of 28 cases

作　　者：李鲁[1] 马黎明[2] 林毅[1] 程前进[2] 邵状[1] 李祥[2] 宋小勇[1] 周君君[1] 褚衍林[1] 

机构地区：[1]解放军第306医院胸心外科,北京100101 [2]济宁医学院附属医院心脏外科

出　　处：《北京医学》2013年第7期512-514,共3页Beijing Medical Journal

摘　　要：目的探讨再次心脏瓣膜替换手术时机和围手术期处理措施。方法选择1988年1月至2012年5月,施行再次心脏瓣膜替换者28例,男12例,女16例,年龄25～45岁;术前心功能Ⅲ级13例,Ⅳ级15例。二尖瓣病变26例,其中二尖瓣生物瓣瓣膜衰坏15例,二尖瓣机械瓣血栓形成致人工瓣膜功能障碍6例,二尖瓣人工瓣膜性心内膜炎并瓣周漏5例;主动脉瓣人工瓣膜性心内膜炎并瓣周漏2例。二尖瓣替换26例,主动脉瓣替换2例,同时施行三尖瓣成形12例。置入机械瓣28例。主动脉阻断时间34～108min,转流时间70～168min。结果早期死亡3例,死因为术后严重低心排出量综合征并多脏器功能衰竭,其余病例术后恢复顺利。随访1～20年,2例于术后2年死于心力衰竭,其余心功能恢复良好。结论及时、准确诊断,合理抉择手术时机及良好围术期处理是提高手术疗效的关键。Objective To explore the appropriate operation time and perioperative treatment measures of reoperation on replaced heart valves.Methods Twenty-eight patients who had experienced reoperation on the replaced heart valve from January 1988 to May 2012 were included in this study.There were 12 males and 16 females with the age ranged from 25 to 45.The preoperative heart function was class Ⅲ in 13 and Ⅳ in 15.Twenty-six cases were mitral valve lesions,in which 15 patients had valve dysfunction caused by bilprostheses failure,6 patients had thrombosis after mechanical mitral valve replacement,5 patients had artificial valvular endocarditis and also associated with paravalvular leakage.Two cases were with aortic valve lesions in whom the valve dysfunction was caused by artificial valvular endocarditis with paravalvular leakage.Mitral valve replacement was performed in 26 cases.Aortic valve replacement was performed in 2 cases.Twenty-eight mechanical valves were employed.Aortic cross-clamped time was 34～108 min,and the cardiopulmonary bypass time was 70～168 min.Results Early death happened in 3 cases because of severe low output syndrome and multiple organ failure,the others recovered completely.During the 1 to 20 years follow-up,2 patients died of heart failure and the cardiac function of others were substantially improved.Conclusions Timely and accurate diagnosis,selecting reasonable surgical time,and strengthening management of postoperative complications are key to improve the outcome of operation.

关 键 词：心脏瓣膜病 瓣膜替换 再次手术 

分 类 号：R654.2[医药卫生—外科学]