严重瓣周漏行瓣膜置换术的疗效评价(附26例临床报告)

Valve replacement for severe paravalvular leakage:an outcome analysis of 26 cases

目的:探讨超声心动图诊断严重瓣周漏的手术疗效。方法:2000年6月至2007年12月收治26例人工瓣膜严重瓣周漏患者,其中男性19例、女性7例;年龄(33～68)岁,平均年龄(48±10.6)岁。其中主动脉瓣位11例,二尖瓣位15例。心功能(NYHA分级)Ⅲ级16例,Ⅳ级10例。术前经胸超声心动图检查结合术中所见是诊断的主要方法。7例患者行保守治疗,19例患者行再次机械瓣置换术。结果:手术组术后早期死亡1例,死于多脏器功能衰竭。长期存活18例,术后随访2个月～8年(平均2.7年),1例术后2个月瓣周漏复发,患者拒绝第3次手术,术后5个月死于心力衰竭。保守治疗组住院期间死亡1例,死于多脏器功能衰竭,术后随访6个月内均死于心力衰竭。结论:对于超声心动图诊断严重瓣周漏的患者应早期手术治疗,保守治疗死亡率高,再次机械瓣置换术可以显著提高严重瓣周漏患者的生存率,且术后心功能明显改善。

Objective： To evaluate the surgical efficacy of valve replacement for severe paravalvular leakage （PVL） by echocardiogram. Methods： From June 2000 to December 2007, 26 patients with severe PVL were admittted to our hospital. The patients included 19 males and 7 females, with a mean age of 48 years （ranging 33 to 68 years）. Severe PVL was reported in 11 cases after aortic valve replacement and 15 mitral valve replacement. The grades of cardiac function was in NYHA Ⅲ （16 cases） and Ⅳ （10 cases）. Preoperation echocardiogram combined with intraoperation findings was the main diagnosis approach. Nineteen patients （73. 1%） underwent a second valve replacement （RO group） and 7 （26.9%） were managed conservatively （MC group）. Results： One patient died of MODS early after operation in the RO group. During 2 months to 8 years follow-up （mean 2.7 years）, one patient had recurrence of paravalvular leakage 2 months later and died of heart failure 5 months later after refusing a second operation. In MC group, one patient died of multiple organ failure in hospital; the rest died within 6 months after operation. Conclusion： Surgical treatment for patients with echocardiogram-diagnosed severe PVL should be performed as early as possible. The mortality and morbidity of conservative therapy are extremely high. Re-operation can greatly improve the long-term survival of the patient and the heart function.