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作 者:于伟勇[1] 张宝仁[1] 梅举[1] 郝家骅[1] 朱家麟[1] 孙道华[1] 黄盛东[1]
机构地区:[1]第二军医大学长海医院胸心外科,上海200433
出 处:《上海医学》2000年第10期599-602,共4页Shanghai Medical Journal
摘 要:目的 评价联合瓣膜病合并巨大左室病人瓣膜替换术的疗效。方法 1 990年 1月至 1 998年 6月间共 5 9例联合瓣膜病变合并巨大左室病人行二尖瓣与主动脉瓣双瓣替换术 ,其中保留二尖瓣全或后瓣下结构2 1例 ,行三尖瓣成形术 42例 ,左房折叠术 1 1例。结果 术后早期并发症 2 5例 ,占 42 .37% ;早期死亡 9例 ,占1 5 .2 5 % ,晚期死亡 4例 ,占 2 .6 7%。影响手术早期疗效的主要因素是术前重度左室扩大 ,收缩末直径 (ESD)≥6 .0cm和舒张末直径 (EDD)≥ 8.0cm ;严重左室收缩功能下降 ,射血分数 (EF)≤ 40 %和短轴缩短率 (FS)≤2 5 % ;围术期室颤和术后严重低心排以及多脏器功能衰竭 ;影响远期疗效的主要因素是室颤和术前严重左室扩大伴收缩功能下降。结论 提高这类病人手术早期和远期疗效的关键是选择合适的手术时机、围术期和术后随访期妥善处理上述高危因素。Objective To evaluate the effectiveness of valvular replacement in patients with multiple valvular lesions associated with giant left ventricle (GLV). Methods Multiple valvular operations were performed in fifty nine patients (male 52, female 7) with GLV between Jan 1990 and June 1998. Combined mitral and aortic valve replacement was performed in all patients with preserved mitral subvalvular structure in 21, tricuspid valve annuloplasty in 42, and left atrium plication surgery in 11. Results The early postoperative complication and mortality rates were 42.3% and 15.25%, respectively. The late mortality rate was 2.67% per patient year. For these patients, the main factors influencing the early surgical results were preoperative severe left ventricular enlargement (ESD≥6.0 cm and EDD≥8.0 cm) and systolic dysfunction (EF≤40% and FS≤25%), perioperative ventricular fibrillation, postoperative low cardiac output and multiple organal failure. And the main factors affecting long term survival were postoperative severe ventricular arrhythmia and left ventricular enlargement with depressed systolic performance. Conclusion The keypoint to improve the early and late results of these kind of patients are the choice of optimum surgical timing, the proper management of the high risk factors mentioned above during perioperative and follow up periods. (Shanghai Med J, 2000,23∶599 602)
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