合并特别巨大左心室心脏手术及围手术期处理

Efficacy of surgical treatment and peri-operative management for intracardiac anomalies combined with huge left ventricular

目的:报道18例特别巨大左心室心脏手术及围手术期处理经验和效果。方法:回顾分析18例合并特别巨大左心室心脏手术后临床资料,左心室舒张末内径(LVEDD)90～112,平均(95.9±11.7)mm。其中,施行主动脉瓣与二尖瓣双瓣膜置换术13例,动脉导管未闭经肺动脉缝闭同时行二尖瓣置换术和主动脉瓣置换术各2例,瓦氏窦瘤破裂修补加主动脉瓣置换术1例。本组同期行三尖瓣环缩成形术12例,二尖瓣置换术均保留全部或部分瓣膜和瓣下结构。术后住重症监护室1～35,平均(9.8±3.5)d。结果:手术早期死亡率33.3%(6/18),死亡原因:猝死2例(33.3%,2/6),肝功能衰竭2例(33.3%,2/6),低心输出综合征1例(16.7%,1/6),呼吸衰竭1例(16.7%,1/6)。存活12例,术后1月复查超声心动图,LVEDD平均(60.6±16.1)mm,较术前显著缩小(P<0.01),心功能恢复良好。结论:合并特别巨大左心室心脏手术风险大,死亡率高,完善的手术以及合理的围手术期处理可减低手术死亡率。

Objective：To evaluate the efficacy of surgical treatment and peri-operative management in 18 cases with intracardiac anomalies combined with huge left ventricular.Methods：The clinical data were retrospectively studied in 18 cases with intracardiac anomalies and combined with huge left ventricular.The mean left ventricular endo-diastolic diameter（LVEDD）of subject was 95.9±11.7 mm（from 90 mm to 112）.The procedure including double valve replacement（DVR）in 13 cases,sutured patent ductus arteriosus（PDA）from pulmonary artery and aortic valve replacement（AVR）or mitral valve replacement（MVR）in 4 cases,and repaired rupture of sinus of Valsalva and AVR in 1 cases.Meanwhile,12 cases underwent tricuspid plication.The mitral valve and subvalvular apparatus had been maintained in patients,which accepted MVR.All patients accepted intensive care in ICU after operation and stayed（9.8±3.5）days（from 1 day to 35 days）.Results：The early mortality rates were 33.30%（6/18）,and the main reasons of early deaths including sudden deaths（33.3%,2/6）,hepatic function fail（33.3%,2/6）,pulmonary failure（16.7%,1/6）,and lower cardiac output syndrome（16.7%,1/6）.The others were cured,and followed-up one month.The echocardiogram showed LVEDD（60.6±16.1）mm,and reduced significantly than preoperational（P〈0.01）.The heart function recovered well.Conclusion：There were high dangers and mortality rates for surgical treatment in intracardiac anomalies combined with huge left ventricular.The perfect operation and correct peri-operative management can decrease operative mortality rate.