二尖瓣置换术中几个问题的探讨

Discussion about the Problems in Mitral Valve Replacement Surgery

本文报告３３４例二尖瓣置换术的临床经验。双房切口径路更有利于左房小或再手术病人的二尖瓣显露。自制双叶瓣的瓣膜质量和血液动力学与国外同类瓣膜相似。持续含氧温血灌注停跳法对心肌保护优于冷晶体停跳液法。术前改善心功和术中注意心肌保护是提高大心脏病人手术疗效的关键。同期合并施行主动脉瓣置换适用于伴有严重主动脉瓣关闭不全的病人。

The experience in mistral valve replacement (MVR) for 334 patients is reported. The biatrial transseptal incision is the best approach for MVR to obtian an optimal exposure to the mistral valve in cases with little enlargement of the left atrium or in cases of redoing cardiac operations. The structural integrity and hemodynamics of newly designed bileaflet mechnical valve, made in Chengdu, are equal to similar products available on the international market. Continuous warm oxygenated blood cardioplegia is superior to cold crystalloid cardioplegia for myocardial protection. Improvement of cardiac function and myocardial protection are the key points to improve the surgical results in patients with giant heart. Combined aortic valve replacement is performed only for patients with severe aortic insufficiency.