27例二尖瓣置换术后左心室后壁破裂的临床分析研究  

Clinical research on the left ventricular posterior wall rupture after mitral vale replacement

作　　者：陈长城[1,2] 徐屹[1,2] 李平[1,2] 徐李力 刘硕[1,2] 高峰[1,2] 尤斌[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管病研究所心外科,100029

出　　处：《心肺血管病杂志》2015年第1期27-31,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:总结二尖瓣置换术后左心室后壁破裂的防治原则。方法:回顾分析北京安贞医院自2001年9月至2012年12月间,共实施二尖瓣人工瓣替换术7 495例,其间发生左心室后壁破裂27例。其中早期破裂6例,延迟破裂21例。同期行主动脉人工瓣替换8例,三尖瓣成形13例,冠状动脉旁路移植术1例,心房颤动射频消融术10例。结果:左心室后壁破裂发生率为0.36%,体外循环下修补与非体外循环下修补相比具有较高的止血成功率(8/16,50%vs.1/11,9.1%,P=0.042)。1例早期破裂患者在体外循环下经心室内修补存活,26例患者院内死亡。全组病死率96.3%。18例死亡原因为修补失败,8例患者死于其它并发症。结论:左心室后壁破裂是高致死性并发症,治疗难度大,效果差,应针对导致该并发症发生的危险因素采取主动预防措施,科学显露二尖瓣、保留二尖瓣后叶及腱索行之有效。体外循环下经左心室内部修补的方法有一定优势。Objective： To summarize the preventive and treatmental strategies on the serious complica- tion, left ventricular posterior wall rupture, after mitral valve replacement. Methods： From September 2001 to December 2012, 7 459 cases mitral valve replacement procedures were performed at Beijing Anzhen Hospital. A retrospective review disclosed that 27 patients encountered with left ventricular posterior wall rupture following mitral valve replacement. Six patients had early ruptures, 21 had delayed ruptures. Concomitant procedures in- cluded aortic valve replacement in 8 patients, tricuspid repair in 13 patients, CABG in 1 patient, radio frequen- cy ablation for atrial fibrillation in 10 patients. Results ： Incidence of left ventricular posterior wall rupture was 0. 36%, successful bleeding control were more likely achieved through repair under cardiopulmonary bypass than through off pump repair （8/16 vs. 1/11, Fisher exact test, P = O. 042 ）. One early rupture patient survived, but the other 26 patients died after the rescuing procedure. The overall mortality was 96. 3%. Eighteen patients died of rescuing procedure failure, and the other 8 patients died of other complications, mainly of multi organ failure. Conclusion： Left ventricular posterior wall rupture following mitral valve replacement is a life threaten- ing complication and is associated with a very high rate of rescuing failure. The best strategy is to prevent its happening based on risk factors analysis. Optimal mitral valve exposure and posterior leaflet chordae preserva- tion of the mitral valve are the most important techniques in preventing this fatal complication. Intraventricular repair under cardiopulmonary bypass is superior to off pump repair.

关 键 词：二尖瓣置换术 左心室破裂 二尖瓣叶保留 

分 类 号：R54[医药卫生—心血管疾病]