人工机械瓣替换术后再次手术的病例分析

The Analysis of Reoperation after Mechanical Valve Prosthesis Replacement

目的 :探讨人工机械瓣替换术后再次瓣膜手术的病因、诊断和手术方式。方法 :复旦大学附属中山医院在 1998年 1月～ 2 0 0 3年 8月 ,对 19例曾接受人工机械瓣替换术的病人行再次瓣膜手术。再次手术的病因为瓣周漏 (13/19)、血栓形成致人工瓣膜或瓣下狭窄 (6 /19)以及原手术中保留二尖瓣瓣下结构致主动脉瓣 (1/19)或二尖瓣瓣下狭窄 (1/19)。再次手术的方式包括瓣周漏修补 (9例 )、左室流出道疏通 (3例 )和再换瓣 (9例 )。再换瓣的病例中 ,1例主动脉瓣小瓣环者置换无支架生物瓣 ,其余均再换机械瓣。结果 :术后 19d死亡 1例 ,住院死亡率 5 .2 6 %。随访 2个月～ 5年 ,共 2 4 .3病人年 ,随访中晚期死亡 3例。其余病人心功能恢复到 1～ 2级。结论 :人工机械瓣替换术后可出现瓣周漏、血栓形成致左室流出道狭窄和人工瓣膜狭窄等而需再次手术。再手术方式包括瓣周漏修补、左室流出道疏通和再换瓣。

Objective: To evaluate the cause, treatment and operation mechod of reoperation after mechanical valve prosthesis replacement. Methods: 19 cases received mechanical valve prosthesis replacement were performed reoperation from January 1998 to August 2003. The cause of reoperation include prosthetic leakage, prosthetic thrombosis and malfunction of mechanical valve. The mechods of reoperation include repairing of prosthetic leakage、extending the outlet of left ventricular and re-replacement with mechanical or biological valve. Results: One died 19 days postoperation, and the hospital mortality was 5.26%. Others were followed up with 24.3 patient years, and three patients died. One died from prosthetic leakage, and two from unknown reason.. All others were recover to NYHA I- II class. Conclusion: Patients received methanical valve prosthesis replacement maybe need reoperation due to prosthetic leakage, prosthetic thrombosis and malfunction of methanical valve. The methods of reoperation include repairing of prosthetic leakage、extending the outlet of left ventricular and re-replacement. And the results are satisfation.