重症心脏瓣膜病的外科治疗

Surgical treatment of valular heart disease

目的总结重症心脏瓣膜病的外科治疗结果,探讨提高早期生存率的措施。方法自2000年6月至2005年7月,对78例重症心脏瓣膜病患者施行瓣膜替换术。其中单纯二尖瓣置换12例,二尖瓣置换+三尖瓣成形22例,单纯主动脉瓣置换8例,二尖瓣+主动脉瓣置换+三尖瓣成形35例,二尖瓣置换+冠状动脉旁路移植术1例。结果死亡6例,其中术后并发低心排血量5例,心室颤动治疗无效死亡1例,死亡率7.69%。随访53例,平均随访2.5年,死亡5例。结论对重症心脏瓣膜病患者,注重改善术前心功能,掌握手术时机,尽量保留瓣下组织,选择合适瓣膜,重视围手术期处理,可提高手术成功率。

Objective To improve the results of valve replacement for the patients with severe valvular heart disease. Methods A retrospective study was carried out for summarizing experience. Between June 2000 and July 2005,78 patients with severe valvular disease were subjected to surgical treatment of valvular replacement. In all of them,mitral valve replacement was performed in 12 cases;mitral valve replacement with tricuspid annuloplasty in 22 cases;aortic valve replacement in 8 cases;both mitral and aortic valve replacement with tricuspid annuloplasty in 35 cases,and mitral valve replacement with coronary artery bypass grafting in 1 case. Results In all 78 cases,72 cases were cured. In 3 cases of death post - operativdy early,2 cases died because of pump failure,and 1 case because of ventricular fibrillation. Conclusion Mitral valve replacement with preservation d valve and the subvalvalar structures,correct selection of artificial valves in both mitral and aortic valve replacement ,and enhancing post- operative treatment can significantly improve the results of valve replacement for the patients with severe valvular heart disease.