二尖瓣置换术后左心室破裂的外科治疗

The surgical treatment for left ventricular rupture after mitral valve replacement

目的探讨二尖瓣置换术后左心室破裂的原因及外科治疗,总结治疗经验。方法回顾性分析江门市中心医院2007年1月~2018年12月期间765例接受二尖瓣置换手术患者的临床资料,其间发生左心室后壁破裂6例。其中早期破裂4例、延迟性破裂2例。早期破裂4例均在体外循环心脏停跳下进行修补。2例延迟性破裂在监护室紧急开胸探查证实诊断后在床边采用非体外循环下心外缝合修补。结果 5例死亡,1例存活。存活者为早期破裂采用心内修补患者。结论二尖瓣置换术后左心室破裂是极凶险的并发症,修补困难,死亡率高。早期破裂患者尽快建立体外循环,经心内修补裂口可能挽救部分患者,延迟破裂者抢救成功率极低,故左心室破裂应以预防为主。

Objective To investigate the cause and surgical treatment of left ventricular rupture after mitral valve replacement(MVR).Methods We retrospectively analyzed clinical data of 6 patients who had left ventricular rupture after MVR,among a total of 765 MVR patients,between January 2007 and December 2018.Four patients who had early ruptures were sutured with extracorporeal circulation,two patients who had delayed ruptures were sutured without extracorporeal circulation.Results Five patients died,one patients was successfully healed.The survival patient was repaired rupture in the heart early.Conclusion Left ventricular rupture is difficult to repair with a high mortality.Once left ventricular rupture occurs during the surgery,extracorporeal circulation should be quickly established,and it’s possible to save patients’ life.The best strategy is to prevent its happening based on risk factors analysis.