人工心脏瓣膜置换术后63例瓣周漏的外科治疗

Surgical Treatment of Periprosthetic Leakage: Report of 25-year Experience with 63 Cases

目的 总结人工瓣膜置换术后瓣周漏（PPL）的外科治疗经验.方法 回顾性分析1980年12月至2005年12月25年间诊治的63例PPL患者的临床和随访资料,其中二尖瓣位34例,主动脉瓣位29例,全部行再次心脏瓣膜置换术.分析PPL的诊断方法和临床分型以及术后早、晚期死亡率、死亡原因和并发症等.结果 围术期发生并发症11例（17.5%）,死亡5例（7.9%）.58例中随访55例,失访3例,晚期死亡5例;长期生存50例,心功能均恢复至Ⅰ～Ⅱ级, 超声心动图随访未发现PPL复发.结论 应重视PPL的病因学、病理生理学以及诊断方法和临床分型的研究.临床中一旦诊断明确,再次心脏瓣膜置换术是治疗PPL确实有效的方法.

Objective To summarize the experiences of surgical treatment for periprosthetic leakage（PPL）. Methods A total of 63 patients with PPL （mitral PPL in 34, aortic PPL in 29）, age 41 - 12 years, underwent reoperation with prosthetic valve replacement from Dec. 1980 to Dec. 2005 in this department. Patient characteristics, operative profiles and follow-up data were described and analyzed in detail. Results The perioperative complications occurred in 11 patients （17. 5%）, five of whom died （the overall hospital mortality; 7. 9%）. Fifty-five patients were in close follow-up and three of them lost in that period, five patients died in late. Fifty patients long-term survivals were in New York Heart Association class Ⅰ- Ⅱ and follow-up evaluation by echocardiography showed no evidence of recurrence or residual PPL and PPL-related complications. Conclusion More attention should be paid to the study on etiology, pathophysiology, diagnostic methods, and clinical classification of PPL. For patients with PPL, reoperation with prosthetic valve replacement is considerably effective and can obtain an acceptable long-term results.