二尖瓣主动脉瓣与三尖瓣联合病变的手术治疗

OPERATIVE TREATMENT OF COMBINED LESION OF MITRAL, AORTIC AND TRICUSPID VALVES

目的 探讨二尖瓣、主动脉瓣与三尖瓣联合瓣膜病变的手术治疗方法和效果。方法 中、低温 ( 2 3～ 2 7℃ )体外循环下手术 ,中度血液稀释 ,主动脉根部灌注心脏冷停跳液 ,心包腔内放置冰屑持续心肌降温 ,切开右心房及房间隔行二尖瓣替换 ,然后作主动脉根部横切口替换主动脉瓣 ,心脏复跳后并行循环下行三尖瓣Devega氏法环缩成形矫治三尖瓣关闭不全。结果 2 8例皆行二尖瓣、主动脉瓣替换加作三尖瓣Devega氏法环缩成形术 ,手术顺利 ,平均住院 2 1.6d ,全部康复出院。随访 3～ 39个月 ,心功能由术前Ⅲ、Ⅳ级转为Ⅰ级者 2 2例 ,Ⅱ级者 5例 ,Ⅲ级者 1例。彩色多普勒复查示 :机械瓣功能良好 ,无瓣周漏 ;三尖瓣成形后返流消失者 19例 ,转为轻度返流者 6例 ,中度返流者 3例。结论 对二尖瓣、主动脉瓣与三尖瓣联合瓣膜病变的病人 ,只要手术时机选择适当 ,认真作好围手术期的处理后积极实施外科手术治疗 ,可取得令人满意的效果。

Objective To explore an operative method and its curative effect in the treatment of the combined lesion of mitral,aortic and tricuspid valves.Methods Operations were performed under extracorporeal circulation and blood dilution with patients' body temperature kept at 23～27℃.Constant myocardiac cooling was got through placing screw ice in the pericardial cavity.The replacement of mitral valve was cmpleted by cutting through the right ventricle and atrial septum;then the artic valve was substituted through the transverse incision of the root of aorta;and at last tricuspid atresia was corrected with the Devega method.The heart beating and blood circulation restored to normal.Results 28 cases underwent the replacement of mitral and aortic valves with the tricuspid atresia corrected through Devega method.The operations turned out to be successful,and the patients all recovered and were discharged from hospital with their hospitalization duration being 21.6 days.According to the follow-up visits for 3-39 months,the patients' cardiac functions restored from Grade Ⅲor Ⅳ to Grade Ⅰ in 23 cases.5 cases got their cardiac functions at Grade Ⅱ and only 1 case at Grade Ⅲ.Reexaminations with Doppler's method showed that the mechanical valves functioned well with no leakage around the valves .Regurgitations disappeared after the formation of tricuspid valves in 19 cases.Slight regurgitation was found in 6 cases and mild regurgitation in 3 cases.Conclusion With operating time chosen properly and peripheral operative measures taken carefully,satisfactory curative effect can be obtained if positive treatment is applied to patients with combined lesion of mitral,aortic and tricuspid valves.