心脏瓣膜病合并冠心病的外科治疗体会

Surgical Management of Valvular Heart Disease Associated with Coronary Heart Disease

目的介绍心脏瓣膜手术同期行冠状动脉旁路移植术的治疗体会。方法 2003年5月至2013年12月,心脏瓣膜手术同期行冠状动脉旁路移植术29例,患者男性13例,女性16例。年龄35-70岁。共搭桥54根。二尖瓣成形术8例;主动脉瓣机械瓣置换术3例;二尖瓣机械瓣置换术10例;主动脉瓣置换及二尖瓣成形术4例;双瓣膜置换术4例。结果术后早期死亡5例,病死率17.24%,其中左室破裂2例,多器官功能衰竭2例,室颤1例。随访3-24个月,心功能改善,无严重心绞痛发作。结论风湿性瓣膜病患者,有冠心病高危因素者,应常规行冠状动脉造影检查。缺血性二尖瓣关闭不全者如瓣膜成形效果差时,应选择保留瓣下结构的瓣膜置换术。

Objective To introduce the outcome of combined valve replacement and coronary artery bypass grafting in patient with valvular heart disease associated coronary heart disease. Methods May 2003 to December 2013, heart valve surgery over the same period coronary artery bypass grafting 29 cases; male 13 cases, female 16 cases. Age 35 to 70 years old. Total bypass 54 root. Results 5 cases death with early postoperative, the death rate was 17.24%, Followed up for 3-16 months, Patients recovered and was discharged with improved heart function. Conclusion Coronary angiography should be carried out routinely in patients with valvular heart disease, especially with coronary heart disease risk factors. Ischemic mitral insufficiency should choose to retain disc directly under the structure of valve replacement, prevent the increased mortality and postoperative complications.