右心瓣膜替换术

RIGHT HEART VALVE REPLACEMENT

本文报告28例右心瓣膜替换术,其中三尖瓣替换(TVR)24例,肺动脉瓣替换(PVR)4例。手术死亡6例,均为TVR病例,死亡率21.4%,死亡与术前心功能差有关。远期随诊2～72个月,除了TVR用机械瓣的患者2例中1例瓣失灵再次手术,1例抗凝过量出血外,余无并发症发生。作者认为,右心瓣膜若需手术,则尽量施行成形术;如病变严重必须换瓣,则首选包括同种瓣在内的生物瓣。

Twenty-eight cases of right heart valve replacement were performed in Fu Wai Hospital form July 1977 to January 1991 with tricuspid valve replacement (TVR) in 24 patients and pulmonary valve replacement (PVR) in 4. The mean age was 24.6±10.5 years. Pathologically the patients were classified into four groups including congenital defect in 12 patients, acquireds inflammation in 9, traumatic in 5 and others in 2. Among the 24 TVR, 7 patients had previous operations. Heart function was poor in most patients, 3 were in class Ⅱ (NYHA), 15 in class Ⅲ, 10 in class Ⅳ. The mean C/T ratio was 0.69±0.10. All of the operations were performed under cardiopulmonary bypass with moderate hypothermia and eardioplegic arrest of the heart. Mechanical valves were used in 17 patients, and tissue valves in 7 patients for TVR. For PVR pulmonary homografts were used in 2 patients, aortic homografts in 1 and Beijing G—K valve in 1. Hospital mortality was 21.4% (6/26). Causes of hospital death included low cardaic output in 3 patients, acute heart failure in 2 and DIC in 1. Twenty patients were followed up, no death occurred. Their heart function was improved and they returned to part-or full-time work.We conclude that most right heart valves can be repaired, but in case of marked deformity, replacement is required. When valve replacement is indicated, tissue valve is preferable: when disc valve is to be used for TVR, the larger orifice of the valve should direct toward the antero-posterior commissure or posterior leaflet of the tricuspid valve so as to prevent disc valve immobilization.