二尖瓣置换术后迟发型左心室破裂诊治分析

Analysis of Delayed Left Ventricle Rupture Following Mitral Valve Replacement

目的探讨二尖瓣置换术后左心室延迟破裂的原因及防治措施。方法对我院收治二尖瓣置换术后左心室迟发破裂的1例临床资料进行回顾性分析。结果本例因风湿性心脏病联合瓣膜病行主动脉瓣、二尖瓣置换及三尖瓣成形术,手术经过顺利,术后6 h出现心包及纵隔引流管有大量血性引流液。患者被立即转运至手术,开胸探查证实为左心室Ⅲ型破裂,行修补术抢救成功,术后顺利出院。结论高龄、左心室偏小和体重较轻是二尖瓣置换术后左心室延迟破裂的危险因素,术中操作粗暴则增加了左心室破裂危险性。左心室延迟破裂一旦明确诊断应急诊手术修补,有可能挽救患者生命。

Objective To explore the cause, prevention and treatment of delayed left ventricle rupture following mitral valve replacement. Methods A retrospective analysis was made on clinical data of a patient with delayed left ventricle rupture following mitral valve replacement. Results The patient with rheumatic heart disease combined with valvular disease undertook successful operations of mitral valve and aortic valve replacement with tricuspid valvoplasty. Six hours after operations a great deal of red blood flow drainage was seen. The patient immediately undertook exploratory thoracotomy and was confirmed as having Type Ⅲrupture. The repair process was successful, and the patient was discharged from hospital after the operations. Conclusion Old age, small left ventricle and light weight are risk factors for patients with left ventricular delayed rupture. Aggressive traction or removal of papillary muscle may increase the risk of left ventricular delayed rupture. As soon as left ventricular delayed rupture is confirmed, intracardiac and extracardiac repair should be made to save the patient＇s life.