人造心脏碟瓣急性功能障碍10例

ACUTE IMMOBILIZATION OF PROSTHETIC DISC HEART VALVE(A REPORT OF 10 CASES)

本文报告10例人造心脏碟瓣急性功能障碍,占同时期碟瓣置换716例的1.4%。发生在术中和术后各5例。二尖瓣位6例,主动脉瓣位3例,三尖瓣位1例。除1例因瓣膜本身质量问题外,余9例均为外源性原因所造成。7例紧急再次手术,存活6例,死亡1例;3例来不及手术均死亡。诊断的建立主要依据病情突然恶化、听诊人造瓣膜声消失。一旦确诊,应迅速再次手术。

From May 1976 to December 1989, disc valvereplacements were performed in 716 cases with10 cases of acute immoblization of the prosthetic valves (1.4%), 5 cases were noticed duringoperation and another 5 cases postoperatively,6 cases in mitrel, 3 in aortic and 1 in tricuspidposition. The causes of acute immobilization wereattributed to extrinsic obstruction in all caseswith one exception which was related to thequality of the valve itself. Among the extrinsicobstruction, long suture ends were found in 4cases, remnant chordae tendineae and rupturedpapillary muscles in 2 eases, left atrial catheterinserted too far in 2 cases and ingrowth of intime in 1 case. Seven of the ten patients experienced emergency reoperation and 6 survived,one died. Another 3 patients died without reoperation. The diagnosis was mainly based on thechange or absence of disc dick sound on auscultationor sudden deterioration of the clinical situation.Emergency operation should be immediately undertaken once the diagnosis was established. Theauthors believe that the surgeon can minimizethe risk of disc immobilization by paying special attention to the followings, (1)Never useoversize disc valve, (2) Remove all remnant intracardiac structures which might cause disc immbilization, (3) Orientation of the valve should beproperly designed, in the mitral position thelarger orifice of the valve should direct towardthe aortic valve and, in the aortic position towardthe noncoronary sinus of Valsalva,(4) Single continuous running suture should be used in mitralimplantation and care must be taken about stitchexits on the sewing ring when interrupted sutureis used, (5) Function of the disc valve must bechecked before and after tying the suture. Trimall ends of the suture, (6) Notice the presence orabsence of click sound when the hear is beating.