二尖瓣置换术后左心室破裂的临床分析

Clinical analysis of the left ventricle rupture after mitral valve replacement

目的总结分析二尖瓣置换术后左心室破裂的经验教训,探讨其防治措施。方法回顾分析11例二尖瓣置换术后发生左心室破裂的诊治经验。结果本组11例,其中男3例,女8例,属于Ⅰ型破裂4例,Ⅱ型破裂3例,Ⅲ型破裂4例;其中9例属于早期破裂,1例为延迟性破裂,1例为晚期破裂。长期存活1例,死亡10例,病死率90.9%。结论二尖瓣置换术后左心室破裂,病死率高,一旦发生,应迅速建立体外循环,积极抢救,但术中、术后采取有效的预防措施更为重要,包括重视高龄妇女、小左心室,提高手术操作技术,选用合适的人工瓣膜及其型号,术后减轻心脏前、后负荷(控制血压)等。

Objective To review the cases of left ventricle rupture after the mitral valve replacement, and to pro- vide evidences for preventive and therapeutic modalities. Methods The diagnostic and therapeutic measures of I 1 pa- tients, with left ventricle rupture after the mitral valve replacement in our hospital, between January 2001 and October 2010, were retrospectively analyzed. Results Out of 11 patients, there were 3 male and 8 female patients. Type I , I] and m rupture were found in 4, 3 and 4 cases, respectively. Meanwhile, early rupture, delayed rupture and late rupture were presented in 9, l and 1 cases, respectively. Only 1 patient survived, with l0 died and mortality of 90. 9%. Conclu- sion The left ventricle rupture after the mitral valve replacement has high mortality. Immediate cardiopulmonary bypass and active salvage are essential in this case. Intraoperative and postoperative preventive measures are more important. These include special care for old women and small left ventricle, improv;ng the operative skill technique, selection of ad- equate artificial valve and size, and reduction anterior and posterior loads （hypertension control） after operation.