心瓣膜病合并巨大左心室44例实施瓣膜置换术效果观察

Valvular heart disease with giant left ventricle by valve replacement

目的分析心瓣膜病合并巨大左心室患者的外科治疗经验,提高瓣膜置换术后的疗效。方法对44例心瓣膜病变合并巨大左心室患者实施瓣膜置换术,其中二尖瓣置换术20例,主动脉瓣置换术14例,二尖瓣+主动脉瓣置换术10例。同时实施三尖瓣成形术13例,左房折叠成形术5例,左房血栓清除术12例。结果术后早期死亡3例(6.8%),死亡原因为心室颤动、低心排出量综合征、肺水肿并呼吸衰竭,其余41例均生存;术后随访6～12个月,超声心动图提示左室舒张末期内径(LVEDD)为65～102 mm,平均(68.3±0.39)mm,较术前均有不同程度的缩小;心功能改善I级6例、Ⅱ级35例。结论 巨大左心室是影响心瓣膜置换手术疗效的重要因素之一。充分的术前准备,术中良好的心肌保护加上恰当的瓣膜处理及严密的术后监护对提高巨大左心室心瓣膜置换术患者疗效至关重要。

Objective To review our experience of operation for patients with valvular heart disease and giant left ventricle in order to improve the results of valve replacement operation.Methods We retrospectively analyzed the clinical data of 44 cases of valvular heart disease with giant left ventricle treated by valve replacement operation in our hospital.Mitral valve replacement was performed for 20 cases,aortic valve replacement for 14 cases,and double valves replacement for 10 cases.Meanwhile 13 cases underwent tricuspid valve plasty,5 underwent left atrial plication,and 12 underwent left atrial thrombus removal.Results There were 3 cases of early death after operation（6.8%）,mainly due to postoperative ventricular fibrillation,low cardiac output syndrome,pulmonary edema,and respiratory failure.The other 41 survived.Follow-up was carried out for 6~12 months.The left ventricular enddiastolic diameter ranged from 65 to 102 mm（68.3±0.39） according to ultrasonic cardiography,which decreased in certain degrees compared with that before operation.Cardiac functions increased to Grade I for 6 cases and Grade II for 35 cases.Conclusions Giant left ventricle is the key to the effect of valve replacement surgery.And full pre-operation preparation,good myocardial protection,appropriate valve handle during the operation,and the intensive post-operation cares are all essential to successful valve replacement surgeries for patients with giant left ventricle.