二尖瓣再次手术患者临床特征分析

Clinical Analysis on the Characteristic Underwent Mitral Valve Reoperation

目的:探讨二尖瓣手术后再次行瓣膜手术的病因和治疗方式。方法:分析2006年1月—2009年12月28例接受再次二尖瓣置换术患者的临床资料。再次手术的病因:二尖瓣成形术后瓣膜进行性病变10例,瓣膜置换术后瓣周漏7例,生物瓣置换术后瓣膜衰败6例,二尖瓣置换术后瓣膜狭窄5例。其中合并人工瓣膜感染性心内膜炎4例,3例血培养阳性,1例瓣膜培养阳性,血栓形成致人工二尖瓣瓣下狭窄1例。结果:术后死亡2例,手术病死率为7.14%。2例死亡患者的死因皆为人工瓣膜感染性心内膜炎。患者随访5个月~5年,随访中2例患者出现严重的房室传导阻滞,行永久起搏器置入术。所有患者术后超声心动图示人工二尖瓣无明显异常,心功能恢复至美国纽约心脏病协会(NYHA)分级I^II级。结论:二尖瓣成形术后瓣膜进行性病变已逐渐成为二尖瓣再次手术的主要原因之一,而术前严格把握二尖瓣成形术的适应证能减少患者再手术的风险。而人工瓣膜感染性心内膜炎作为瓣膜手术严重和高致死率的并发症,应对其有充分的认识,应早发现、早检查、早治疗,为手术争取足够的时间。

Objective：To study the risk factors and treatment methods of the re-valve surgery after mitral valve operation.Methods：From January 2006 to December 2009,a total of 28 patients underwent the second mitral valve replacement after their first mitral valve repair or replacement surgery.Among the patients who received mitral valve replacement for the first time,7 patients had perivalvular leakage,6 patients happened the degeneration of the artificial biovalves,5 patients were valve stenosis.Among these patients,4 were complicate with artificial valve endocarditis,with 3 positive of the blood culture,and 1 negative.One patient have infravalve stenosis of the artificial valve was because of thrombogenesis.Ten patients received the mitral valve replacement operation because of the degeneration of mitra valve after valve repair surgery.Results：Two patients were dead after operation,and the fatality rate was 7.14%,both were complicated with artificial valve endocarditis.The follow up was 5 months to 5 years.Two patient had severe atrioventricular block,and both received permanent pacemaker implantation in our hospital.All patients received cardioultrasonogragh,and the results showed the artificial valves worked well,and their cardiac function had been from I to II degree of the New York Heart Association（NYHA） functional cbassification.Conclusions：The degeneration of mitra valve after valve repair surgery has been gradually become the major cause of reoperation of the mitral valve,to restrict the indication of repair surgery can decrease the risk of reoperation.Prosthetic valve endocarditis is a severe complication with high mortality,we should discover it earlier,treat it earlier,to save enough time for the operation.