摘要
1993年1月至1996年12月,作者等对120例患者施行了二尖瓣和主动脉瓣双瓣联合置换术,占同期瓣膜手术的41％。其中117例为风湿性心脏病,3例为瓣膜退行性病变。45例患者同时接受了三尖瓣成形术(44例De Vega成形、1例Carpentier环成形),2例患者接受了三尖瓣置换术,1例患者接受了冠状动脉搭桥术。术后早期死亡3例(死亡率2.5％),低于同期瓣膜置换术的总体死亡率(3.8％)。其余117例患者中虽然也出现了一些并发症如出血、脏器功能不全、感染等,但术后恢复相对平稳,术后平均21天痊愈出院。为了降低手术死亡率,除了重视术前准备、加强围术期管理和改善体外循环灌注和心肌保护技术以外,强调在术中要尽量保持二尖瓣与左心室的连续关系、积极处理三尖瓣病变、必要时积极扩大主动脉瓣环。
From January 1993 through December 1996, 120 consecutive patients received combined mitral and aortic valve replacement in our hospital. This represented 41 % of total valvular operations during that period. 117 of them were with rheumatic valve disease and the other 3 cases were with degenerative valve lesions. 45 patients underwent associated tricuspid valvuloplasty(44 De Vega and 1 Carpentier ring), 2 patients had tricuspid valve replacement and 1 had coronary artery bypass grafting. 3 patients died following operation, the mortality(2. 5% ) was less than that of the total valve replacement patients(3.8%) who received surgery at the same time. The other 117 patients had a relatively uneventful postoperative recovery and discharged at a mean time of postoperative 21 days even though some complications such as hemorrhage,organ insufficiency or infection had occurred. In order to decrease the surgical mortality of double valve replacement, the key factors of keeping the continuity between the mitral annulus and the left ventricle, treating the concomitant tricuspid valve disorders and enlarging the aortic annulus as necessary during operation, on the bases of good preoperative preparation, ideal perioperative management, optimal cardiopul-monary bypass perfusion and 'perfect' myocardial protection had been emphasized.
