二尖瓣置换术后左心室后壁破裂的外科处理  

The surgical treatment for left ventricular rupture after mitral valve replacement

作　　者：石娟[1] 肖杰文 魏翔 冯鑫 SHI Juan;XIAO Jie-wen;WEI Xiang;FENG Xin(Division of Cardiothoracic and Vascular Surgety,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医院学院附属同济医院心脏大血管外科,湖北省武汉市430000

出　　处：《中国心血管病研究》2021年第6期535-539,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨二尖瓣置换术后左心室后壁破裂的外科治疗、预防措施及经验。方法回顾2011年1月至2020年12月我院所接收二尖瓣置换术后发生左心室后壁破裂的11例患者的临床资料。其中早期破裂6例,延迟破裂5例,Ⅰ型2例,Ⅱ型3例,Ⅲ型1例,无法分型5例。6例早期破裂均在发现后立即体外循环下进行修补,5例延迟破裂其中3例二次开胸手术干预前复苏失败死亡,2例二次开胸体外循环下进行修补。修补方法包括2例内外联合修补,6例外修补,其中有3例患者在内外修补的基础上还接受了新的修补方法—左心室后壁大包裹的方法。结果 11例患者中3例在手术干预前死亡,4例修补失败术中死亡,4例修补成功。修补成功的患者中1例术后死亡,死于低心排血量综合征,3例存活并最终出院。最终病死率72.7%,进行左心室后壁破裂修补的存活率为37.5%。结论二尖瓣置换术后左心室后壁破裂罕见且病死率极高,一经诊断,立即在体外循环下进行修补是挽救患者生命的可行性方案,及早识别高危患者并在术中及术后进行预防至关重要。Objective To investigate surgical treatment, preventive strategies and experience of left ventricular rupture after mitral valve replacement(MVR). Methods We retrospectively analyzed clinical data of 11 patients who had left ventricular rupture after MVR from January 2011 and December 2020. Among them, there were 6 patients with early rupture and 5 patients with delayed rupture;And, there were 2 cases of type Ⅰ left ventricular rupture, 3 cases of type Ⅱ, 1 cases of type Ⅲ. The other 5 cases could not be classified into any type.The 6 patients of early rupture all were repaired under cardiopulmonary bypass. Among the 5 patients of delayed rupture, 3 patients died of resuscitation failure before secondary sternotomy intervention, 2 patients were repaired under cardiopulmonary bypass. The repair methods included internal & external repair in 2 cases and external repair in 6 cases. On the basis of internal and external repair, we also carried out a new repair method in 3 patients——large wrapping of left ventricular posterior wall. Results Among the 11 patients, 3 patients died before surgical intervention, 4 patients died in operation due to repair failure, and 4 patients were repaired successfully.Among the patients with successful repair, 1 patient died of low cardiac output syndrome, and 3 cases survived and eventually discharged from hospital. The final mortality rate was 72.7%, and the survival rate of repair of left ventricular posterior wall rupture was 37.5%. Conclusion Left ventricular posterior wall rupture after mitral valve replacement is rare, but the mortality rate is extremely high. Once diagnosed, immediate repair under cardiopulmonary bypass was an available treatment to save some patients’ lives. But it is more important to identify high-risk patients early and prevent them during and after operation.

关 键 词：二尖瓣置换术 左心室后壁破裂 外科治疗 危险因素 预防 

分 类 号：R654.2[医药卫生—外科学]