重症风湿性心脏瓣膜病的外科治疗

The Surgical Treatment of 28 Cases of Severe Rheumatic Heart Disease

目的探讨重症风湿性心脏瓣膜病变的外科综合治疗经验。方法胸心外科共收治28例重症风湿性心脏瓣膜病患者并进行了瓣膜置换术,其中二尖瓣置换(MVR)14例,二尖瓣、主动脉瓣双瓣置换AVR+MVR10例,主动脉瓣置换AVR4例,3例同时行改良三尖瓣DEVEGA法环缩。结果死亡1例(3.8%),死亡原因为心包填塞。随诊患者2月～2年,心功能显著改善。结论注重术前准备,选择适当手术时机,完善手术操作,避免手术不当引起并发症及加强术后并发症处理可进一步提高重症风湿性心脏瓣膜病的外科疗效。

Objective To improve the perioperative treatments for severe rheumatic heart disease.Methods 28 patients with severe severe rheumatic heart disease underwent heart at our institution from December 2007 to November 2009.Among these patients,the etiology was mitral valve regurgitation in 14 patients,mitral and arotic valve regurgitation in 10,arotic valve regurgitation in 4.All patients received valve replacement,and 3 of which were treated modified tricuspid De Vega annuloplasty at the same time.Results One case died from pericardial tamponade,other patients were discharged from the hospital,and had improved cardiac function.Conclusion Patients with severe rheumatic heart disease can receive better surgical treatment if reasonable patients were made energetic preoperative provision,performed consummate operative procedure.