心脏瓣膜疾病合并巨大左室的外科治疗

Surgical treatment for heart valve diseases with giant left ventricle

目的总结心脏瓣膜病合并巨大左室患者的外科治疗经验。方法回顾分析我科近年连续施行合并巨大左室的瓣膜置换术61例，其中双瓣置换24例，二尖瓣置换14例，主动脉置换23例。结果术后早期并发症18例（29．5％），死亡4例（6．6％），主要并发症和死因是低心排综合征和室颤。左室舒张末内径在术后2周、3个月均明显缩短（P〈0．01）；左室射血分数和短轴缩短率在术后2周明显下降（P〈0．01），3个月恢复到术前水平。结论选择手术时机、防治低心排综合征和心室纤颤是手术成功的关键环节。

Objective To summary the experience of heart valve replacement for the treatment of heart valve diseases complicated with giant left ventricle. Methods Clinical data of 61 patients with both heart valve disease and giant left ventricle who were subjected to heart valve replacement were retrospectively analyzed. There were combined mitral and aortic valve replacement in 24 cases, mitral valve replacement in 14 and aortic replacement in 23. Results The early complication and mortality rate were 29.5% and 6.6% ,respectively. Left ventricular end - diastolic dimension （LVEDD） was reduced significandy 2 weeks and 3 months after the operation as compared with that before the operation （ P 〈 0.01 ） while ejection fraction （EF）and fractional shortening （FS）declined significantly （P 〈 0.01 ）2 weeks after operation, returning to the preoperative level. Conclusions Optimal surgical timing and early management of low cardiac output syndrome （LCOS） and ventricular fibrillation are the key for the success of valve replacement for the patients with giant left ventricle.