鲁登巴赫综合征的外科手术抉择(附21例临床报告)

Surgical Treatment of Lutembacher's Syndrome:21 Cases Report

目的总结分析鲁登巴赫综合征的外科治疗效果,探讨其手术治疗的术式抉择和处理要点。方法21例鲁登巴赫综合征患者均在低温体外循环下手术,17例行二尖瓣机械瓣置换术(选用25号瓣14例,27号瓣3例),4例行二尖瓣成形术。房间隔缺损直接缝合17例,补片修补4例。同期行三尖瓣成形术17例,左心耳结扎4例。结果本组因室颤死亡1例,余均顺利出院,心功能明显改善。无一例出现与手术相关的严重并发症。术后右房、右室、左房舒张末直径分别为(41.3±6.0)mm、(41.8±4.4)mm、(35.4±6.6)mm,均明显小于术前的(53.5±5.9)mm,(51.7±6.2)mm和(48.7±9.6)mm;术后跨二尖瓣口压差为(19.2±6.3)mmHg,平均肺动脉压为(24.4±6.5)mmHg,均明显低于术前的(29.5±10.4)mm-Hg和(36.2±10.5)mmHg;术后射血分数为74.8%±11.0%,高于术前的67.0%±12.4%(P<0.05)。结论外科手术治疗鲁登巴赫综合征宜采用小口径的机械二尖瓣置换和直接缝闭房间隔缺损。术后积极改善肺动脉高压,保护左室功能,严格控制心房颤动是手术成功的关键。

Objective To discuss the effect of surgical treatment, and further to select the proper procedure and perioperative care for Lutembacher＇s syndrome. Methods 21 cases of Lutembacher＇s syndrome were underwent surgical treatment under low temperature cardiopulmonary bypass. The mitral valve replacement was performed in 17 cases, including 25# mechanical prosthetic valve （MPV） in 14 cases and 27# in 3 cases. And the mitral valvuloplasty was performed in the other 4 cases. The atrial septal defects （ASD） were closed by direct suture in 17 and auto pericardium patch in 4. The tricuspid valvloplasty was underwent in 17 and left atrial appendage ligation in 4 simul- taneously. Results One patient died of ventricular fibrillation, the others discharged with better cardiac function. No severe complications related to the operation occurred. The postoperative end-diastolic diameters of right atrium, right ventricle and left atrium were 41.3 ±6.0, 41.8 ±4. 4 and 35.4 ±6.6 mm respectively, and were obviously shorter than 53.5 ±5.9, 51.7 ±6.2 and 48.7 ±9.6 mm of pre-operation respectively; the mean mitral pressure gradient and mean pulmonary arterial pressure was 19.2 ±6.3 rnmHg and 24. 4 ±6.5 mmHg respectively, both were remarkablely lower than 29. 5 ± 10.4 rnmHg and 36. 2 ±10. 5 mmHg respectively of pre-operation; the postoperative ejection fraction was 74. 8% ± 11.0%, and was significantly higher than 67.0% ± 12.4% of pre-operation（ P 〈 0.05）. Conclusions The mitral valve replacement with small diameter MPV （such as 25#） and ASD closure by direct suture are the good choices for the surgical treatment of Lutembacher＇s syndrome. The appropriate post-operative management of pulmonary hypertension, left ventricular function and atrial fibrillation actively may be the key point to achieve a satisfactory effect.