二尖瓣重度狭窄伴小左心室的外科治疗体会

The surgical treatment experience of severe rheumatic mitral stenosis patient with small left ventricle

目的 总结风湿性心脏病二尖瓣重度狭窄伴小左心室（左心室舒张末期内径≤40 mm）患者的外科治疗经验。方法 292例风湿性心脏病患者于2012-04~2013-07在该科接受体外循环心脏直视手术治疗,其中3例患者系二尖瓣重度狭窄伴小左心室,该文对此3例患者的临床资料进行回顾性分析。结果 1例患者术后出现低氧血症、肺部感染、低心排、急性肾功能衰竭,予以呼吸机辅助呼吸、主动脉内球囊反搏（IABP）支持和床旁透析治疗,效果不佳,于术后第6天死于多器官功能衰竭;其余2例痊愈出院,心功能恢复至Ⅰ~Ⅱ级。随访13~18个月,心脏彩超显示左心室舒张末期内径分别为45 mm和46 mm,左心室射血分数分别为0.78和0.76,均较术前改善。结论 小左心室患者病程长,病情重,多合并三尖瓣关闭不全及肺动脉高压,晚期部分患者可发展为左心室萎缩及右心功能不全,手术风险大,病死率高;重视围术期处理,可以提高手术疗效。

Objective To summarize the surgical treatment experience of severe rheumatic mitral stenosis patients with small left ventricle（left ventricular end diastolic diameter ≤40 mm）. Methods From April 2012 to July 2013, 292 rheumatic heart disease patients including severe mitral stenosis patients with small left ventricle were performed open heart surgery by cardiopulmonary bypass. The clinical data of 3 severe mitral stenosis patients with small left ventricle were analyzed retrospectively. Results One patient died of muhiple organ failure secondary to hy- poxemia, pulmonary infection, low cardiac output syndrome and acute renal failure. The other 2 patients were cured and discharged, and their cardiac function recovered to grade I - II. During the following-up period with 13 to 18 months, left ventricular end diastolic diameters of 2 patients were 45 mm and 46 mm respectively, and left ventricular ejection fractions were 0. 78 and 0. 76 respectively. The two indexes were improved compared with preoperative indexes. Conclusion Severe rheumatic mitral stenosis patients with small left ventricle usually associate with long duration, serious condition, tricuspid valve insufficiency and pulmonary arterial hypertension, even a part of patient develops into left ventricular atrophy and right heart insufficiency in advanced stage. Severe rheumatic mitral stenosis patients with small left ventricle have greater operation risk and higher mortality.