摘要
1987年1月至1992年3月,我们为65例心脏瓣膜病巨大左室(EDD>70mm)病人施行了瓣膜替换术。术前平均EDD78.8mm,ESD57.3mm,FS0.26。心功能Ⅲ级16例,Ⅳ级49例。手术方式:MVR16例,MVR+TVP10例,AVR11例,MVK+AVR21例,MVR+AVR+TVP7例。术后早期发生心、肺、肾、肝等重要器官并发症27例,死亡9例(13.8%)。AVR组(18.2%)和DVR组(17.9%)死亡率显著高于MVR组(7.7%)。术后2~4周超声心动图复查,左室EDD、ESD均较术前有显著缩小。而FS、EF至术后6~12个月才较术前有显著改善。长期生存56例中52例心功能Ⅰ级42例,Ⅱ级9例,Ⅲ级1例;晚期死亡4例。我们认为,加强围术期处理、强调心肌保护与手术方法的改进,是提高心脏瓣膜病巨大左室病人手术疗效的重要措施。
Sixty-five patients with valvular heart disease associated with giant left ventricle (left ventricular end-diastolic diameter EDD>70mm)were operated on for cardiac valve replacement in our hospital from Jan.1987 through March 1992.Preoperative EDD was 78.8(70.0~98.3)mm,ESD 57.3(50.2~72.8)mm,FS 0.26(0.12~0.33),cardiac/thoracic ratio was from 0.64 to 0.98.NYHA heart function class was Ⅲ in 16 and class Ⅳ in 49.Among them,17 patients had functional tricuspid insufficiency,14 severe impairment of pulmonary function,19 higher than moderate pulmonary hypertension,11 hepatic dysfunction,3 renal insufficiency.Operative procedures consisted MVR in 16 cases,MVR+TVP in 10,AVR in 11,MVR+AVR in 21,MVR+AVR+TVP in 7.Early postoperative complications in 27 patients included low cardiac output syndrome,respiratory failure,renal failure and MOF.Nine deaths occurred within 30 days (13.8%).The mortality in AVR (18.2%) and DVR(17.9%) was significantly higher than that in MVR(7.7%).Postoperative echocardiographic examinations between 2~4 weeks showed that LVEDD and LVESD were decreased significantly and LVFS and EF were not improved significantly as compared with preoperative values respectively,but had sigificantly increased 6 to 12 months postoperatively.The averaged follow-up time of 56 survivals was 2.77 years(6 months to 5.4 years).There were 4 late deaths (2.78% patient-year).of the 52 long-term survivors their heart function was class Ⅰ in 4,cases,Ⅱ in 9,Ⅲ in 1.The authors think that preoperative improvement of patient’s general condition and cardiopulmonary function,enhancing myocardial protection and optimal operative methods during operation,and intensiying postoperative management were important factors affecting operative results of valvular heart disease with giant left ventricle.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
1994年第4期289-292,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏瓣膜疾病
巨大左室
心脏瓣膜置换
Valvular heart disease
Giant left ventricle
Cardiac valve replacement