急诊心脏瓣膜替换25例报告

25 cases report of emergency heart valve replacement operation

目的:探讨急诊心脏瓣膜替换手术时机和围手术期处理措施。方法:1995年1月至2009年5月,对急性心脏瓣膜功能障碍致急性心肺功能衰竭施行急诊瓣膜置换25例,其中男性15例,女性10例,年龄12～64岁,术前心功能均为Ⅳ级。二尖瓣病变17例,其中二尖瓣机械瓣替换术后血栓形成致人工瓣膜功能障碍7例,人工瓣膜性心内膜炎并瓣周漏4例,感染性心内膜炎致急性二尖瓣腱索及乳头肌断裂并二尖瓣重度关闭不全5例,二尖瓣关闭不全并预激症1例。主动脉瓣病变8例,其中感染性心内膜炎并主动脉穿孔致急性心力衰竭(心衰)3例,血栓形成致人工瓣功能障碍2例,主动脉关闭不全并主动脉窦瘤破裂致急性心衰2例,外伤性主动脉瓣撕裂致主动脉瓣重度关闭不全1例。二尖瓣替换18例,其中再次心脏瓣膜替换11例,同时施行三尖瓣成形9例,异常传导束旁路切断1例。主动脉瓣替换8例。置入机械瓣22例,生物瓣3例。主动脉阻断时间34～80 min,转流时间70～160 min。结果:早期死亡1例,死于术后严重低心排综合征(低心排),其余病例术后恢复顺利,随访1～13年,心功能恢复良好。结论:及时、准确诊断,果断抉择手术时机,合理选择术式及良好围术期处理是进一步提高手术疗效的关键。

Objective：To explore operation chance and perioperative treatment measures of emergency heart valve replacement.Methods：25 patients endured emergency heart valve replacement operation for acute cardiorespiratory failure because of acute cardiac valvular dysfunction from January 1995 to May 2009.There were 15 males and 10 females with an age range from 12 to 64.Preoperative heart function all was class Ⅳ.Mitral valve lesions were 17 cases.7 patients had artificial valve dysfunction caused by thrombosis after mechanical mitral valve replacement,4 patients had artificial valvular endocarditis and parabasilar leak,5 patients had severe mitral valve insufficency because of the rupture of chordae tendineae and papillary muscle of mitral valve with infective endocarditis,and 1 patients had mitral valve insufficency with W-P-W syndrome.8 cases had aortic valve lesions,of which 3 cases had acute heart failure caused by infective endocarditis and aortic perforation,2cases had artificial valve dysfunction because of thrombosis,2 cases had acute heart failure caused by severe aortic insufficency with aortic sinus aneurysm rupture,and 1case had severe aortic insufficiency caused by traumatic tear of aortic.Mitral valve replacement was performed in 18 cases,of which heart valve reoperation in 11 cases,tricuspid annuloplasty in 9 caese,surgical interruption of the Bundle of Kent in the patient with W-P-W syndrome in 1.Aortic valve replacement was performed in 8 cases.22 mechanical valves and 3 bilprostheses were employed.Aortic cross-clamped time was 34-80 min,and cardiopulmonary bypass time was 70-160 min.Results：The early death was 1 case because of severe low output syndrome,the others recovered smoothly.The patients were followed-up 1-13 years,and their cardiac function satisfied.Conclusion：Timely and accurate diagnosis,resolute surgical chance,reasonable selection of operation method and strengthening management of postoperative complication are the key to improving operation effect.