合并巨大左心室的心脏瓣膜病术后远期疗效分析  

Long-term follow up of surgical treatment for heart valve diseases with severe dilated left ventricle

作　　者：李晓勇[1] 金晶[1] 陶超 许铭 LI Xiao-yong;JIN Jing;TAO Chao;XU Ming(Department of Cardiac Surgery of Wuhan Asia Heart Hospital,Hubei Province Key Laboratoty of Occupational Hazard Identification ami Control,Wuhan University of Science und Technology,Wuhan 430022,China)

机构地区：[1]武汉科技大学附属武汉亚洲心脏病医院心外科,职业危害识别与控制湖北省重点实验室,湖北省武汉市430022

出　　处：《中国心血管病研究》2020年第12期1103-1105,共3页Chinese Journal of Cardiovascular Research

基　　金：湖北省卫生健康科研基金(WJ2019H238);武汉市卫生计生科研基金(WX18Q33、WX17B19);武汉中青年医学骨千人才培养工程。

摘　　要：目的 探讨合并巨大左心室的心脏瓣膜病行手术矫治后的远期疗效及左心室重构情况,为临床诊治提供经验.方法 回顾性分析武汉亚洲心脏病医院2000年1月至2010年12月收治的117例合并巨大左心室的心脏瓣膜病的住院资料门诊及电话随访结果.男性71例,女性46例,平均年龄(54.2±17.1)岁;术前左心室舒张末直径(left ventricular diastolic diameter,LVEDD)为(76.2±7.4)mm,左心室射血分数(left ventricular ejection fraction,LVEF)为(41.5±8.2)%.结果 行二尖瓣置换术48例,二尖瓣成形术11例,主动脉瓣成形术2例,主动脉瓣置换术31例,主动脉瓣二尖瓣联合瓣膜置换术25例.围手术期死亡率6.8%(8/117),室性心律失常19例(16.2%),多器官功能不全11例(9.4%),低心排血量综合征46例(39.3%).随访时间9~17年(中位数11年),失去随访6例,死亡12例,生存的91例中,临床心功能Ⅰ~Ⅱ级85例,Ⅲ级6例.术后1个月时平均LVEDD为(68.4±5.4)mm,术后1年时为(60.7±8.4)mm,最近一次随访为(62.3±9.4)mm,均较术前明显降低(P均<0.05).LVEF在术后早期为(36.5±4.7)%,较术前降低(t=3.02,P=0.005),术后1年时恢复至术前水平(43.2±7.9)%.结论 合并巨大左心室的心脏瓣膜病手术风险高,但远期预后可,术后左心室功能基本能得到较大改善.Objective To explore the long-term outcome and the left ventricular remodeling after the surgical trcatment for the heart valve diseases with severe dilated let ventrcle.Methods 117 hospitaized cases that underwent operatin for heart valve disases with severe dilated left ventricle from Jan.20000 to Dec.2010 were included in the study.71 were male and the others were female.The average age at operation was(54.2±17.1)years old.The let vnticar distoic diante(LVEDD)was(76.2±74)mm before operation and the left venticular ejction fraction(LVEP)was(41.5±8.2)%.Results The cohort incuded 48 mital valve replcense,11 mirtal valve repairs,31 aoric valve rpalcenaste,2 aortic valve repais and 25 aortic combined mital valve rplacent.The prioperataiv motaity was (39.3%).There were 19 ventricular arhyhmias(16.2%),1I multiple organ failure(16.2%)and 46 low cardiac output syndrome(39.3%)during the carlier postoperative period.At a median fllow-up of 11 yers(range from 9 to 17 years),there was 6 lost contact and 12 died.Among the 91 lived cases,85 were in New York FHeat Asocation I to Ⅱ and 6 in Ⅲ.The LVEDD was(68.4+5.4)mm one month after the operation and(60.78.4)mm one year afer the opertion.The latest fllow-uo showed the LVEDD was(2394)mm,which was smale than that pe-operato(P<0.05).The LVEF was(36.5±4.7)%afer the operation,which was decreased than pre operation(t=3.02,P=0.005).But the LVEF was(43.2±7.9)%and developed into normal onc year afer the operation.Conclusion The surical crrection of heart valve diseases with severe dilated left ventricle has high risk and more complications,but the long term outcome is apreciable.The left ventricular function could be improved after the operation.

关 键 词：心脏瓣膜病 大左心室 手术 预后 左心室重构 

分 类 号：R654.2[医药卫生—外科学]