二尖瓣置换术后再次开胸行二尖瓣置换、三尖瓣成形和左心房折叠术1例报告  

Mitral valve replacement,tricuspid valvuloplasty and left atrial plication after mitral valve replacement:a case report

作　　者：钱松屹 QIAN Songyi(Department of Cardiac Surgery,Xiamen Branch,Zhongshan Hosptial,Fudan University,Xiamen 361015,China)

机构地区：[1]复旦大学附属中山医院(厦门)心外科,厦门361015

出　　处：《上海医药》2022年第19期32-35,38,共5页Shanghai Medical & Pharmaceutical Journal

摘　　要：二次换瓣患者的手术风险较高,尤其是术前心功能不全的患者。我科收治了1例20余年前接受二尖瓣置换术的患者,其近4年来活动后胸闷、气促,超声心动图检查示人工机械二尖瓣运动可,但双心房、右心室增大伴重度三尖瓣反流,重度肺动脉高压,纽约心脏协会心功能分级Ⅲ级,诊断为三尖瓣反流(重度)、二尖瓣置换术后、慢性心功能不全。经行三尖瓣成形、再次二尖瓣机械瓣置换和左心房折叠术,患者术后恢复可,一般情况改善,给予强心、利尿、抗凝等治疗。术后1.5年时随访,患者无不适,纽约心脏协会心功能分级Ⅱ级。Patients with secondary valve replacement have higher surgical risk,especially those with preoperative cardiac insufficiency.A patient who underwent mitral valve replacement more than 20 years ago was admitted to our department.She had chest tightness and shortness of breath after activities in the past 4 years.Echocardiography showed that the artificial mechanical mitral valve function was normal,but the double atrium and right ventricle were enlarged with severe tricuspid regurgitation and severe pulmonary hypertension.She was diagnosed as tricuspid regurgitation(severe),post mitral valve replacement,chronic cardiac insufficiency,cardiac function grade Ⅲ(New York Heart Association classification).The patient recovered well and her general condition was gradually improved after tricuspid annuloplasty,mechanical mitral valve replacement and left atrial plication were successfully performed.The patient was continuously treated with cardiotonic,diuretic and anticoagulant for about three months till clinical symptoms disappeared.After 1.5 years of follow-up,the patient had no discomfort and cardiac function gradeⅡ.

关 键 词：心脏瓣膜置换术 三尖瓣成形术 左心房折叠术 人工瓣膜-患者不匹配 

分 类 号：R654.2[医药卫生—外科学] R542.5[医药卫生—临床医学]