多瓣膜病变的外科治疗

SURGICAL TREATMENT OF MULTIPLE VALVULAR DISEASES

目的：回顾总结多瓣膜病变的外科治疗经验。方法：为４０例多瓣膜病变患者行手术治疗，其中风湿性心脏病３９例，细菌性心内膜炎１例。瓣膜病变类型：二尖瓣、主动脉瓣联合组１９例，二尖瓣、三尖瓣联合组１７例，二尖瓣、主动脉瓣和三尖瓣联合组４例。术前心功能分级：Ⅲ级１７例，Ⅳ级２３例。手术均在中度低温体外循环下进行，术中应用综合心肌保护法。结果：术后３０日内死亡２例，手术死亡率５％。死亡原因为低心排综合征和呼吸衰竭。结论：精心的外科治疗可使多瓣膜病变患者取得满意的疗效。

Objective:To sum up the experience with surgical treatment of multiple valvular diseases.Methods:Forty patients of multiple valvular diseases underwent operation,including 39 cases of rheumatic heart diseases,1 case of bacterial endocarditis.The types of valvular disease included mitral valve combined with aortic valve disease in 19 cases,mitral valve combined with tricuspid valve disease in 17 cases,mitral valve,aortic valve combined with tricuspid valve disease in 4 cases.The preoperative function of the heart belonged to grade Ⅲ in 17 cases,grade Ⅳ in 23 cases.All operations were performed under cardiopulmonary bypass with moderate hypothermia.The comprehensive methods of myocardial protection were used during the operation.Results:Two cases died within 30 days of operation,with an early operative mortality rate of 5%.The cause of early death was low cardiac output syndrome and respiratory failure.Conclusion:Perfect surgical treatment secures satisfactory results in the patients with multiple valvular diseases.