重症瓣膜病的外科处理

Surgical Treatment of Severe Valve Heart Diseases.

目的 探讨重症瓣膜病的治疗方法。方法 回顾性分析156例因重症心脏瓣膜病变行瓣膜置换术患者的临床资料，其中风湿性心脏瓣膜病148例行瓣膜置换术，术中视三尖瓣病变情况和左心房大小行三尖瓣成形术和左心房折叠术8例，冠状动脉病变患者同时行搭桥术。结果 因重症风湿性心脏瓣膜病而行瓣膜置换术的患者有8例早期死亡，其中因左心室低心排血量综合征死亡4例，心律失常死亡3例，左心室后壁破裂死亡1例。因冠状动脉病变，在行瓣膜置换术的同时行冠状动脉搭桥的患者无早期死亡。2例重症风湿性心脏瓣膜病患者在术后6个月和20个月因瓣周漏而再次行瓣膜置换术。术后生存的患者112例随访6—12个月．心功能Ⅰ-Ⅲ级。结论 合理的手术方式和术后处理是治疗重症瓣膜病的关键。

Objective To explore the treatment of severe valve heart diseases. Methods The clinical data of 156 cases of severe valve heart diseases were retrospectively analyzed, including 148 cases of rheumatic valvular diseases of the heart. During operation the patients underwent tricuspid valvuloplasty and left atrial flapping according to the lesion of＇tricuspid valve and the size of left atrium in 8 cases. The patients with coronary artery lesion underwent coronary artery bypass. Results Among those patients,8 cases died at early stage after valve replacement because of severe rheumatic valve heart diseases,4 of them died of low output syndrome of left ventricle,3 died of arhythmia, and 1 died of rupture of posterior wall of left ventricle. There was no early death in the patients undergoing replacement of valve as well as coronary artery bypass. 2 patients with severe rheumatic valvular diseases underwent replacement of valve because of leakage of valve surrending area 6 months and 12 months after operation. The survived 112 patients were found to be with class Ⅰ -Ⅲ of heart function during 6-12 months of follow up. Conclusion Proper surgical treatment and postoperative management are the key to the treatment of severe valve diseases.