115例危重心脏瓣膜病的外科治疗

Surgical Treatment on 115 Patients with Critical Cardiac Valve Disease

目的 探讨危重心脏瓣膜病手术治疗和围术期处理的经验。方法 1998年 5月至 2 0 0 2年 9月危重心脏瓣膜病患者 115例接受手术治疗 ,其中男性 4 7例 ,女性 6 8例 ;年龄 16岁～ 75岁。术前心功能 级 4 8例 ,心功能 级 6 7例。二尖瓣置换术 4 8例 ,主动脉瓣置换术 18例 ,二尖瓣加主动脉瓣置换术 4 9例 ;同时行三尖瓣成形术33例 ,三尖瓣置换术 1例 ,左房血栓清除术 2 2例 ,左房折叠术 18例 ,冠状动脉搭桥术 3例。结果 早期主要并发症为室性心律失常、低心排血量综合征、呼吸衰竭和多器官功能衰竭。早期死亡 5例 ;其中室性心律失常 1例 ,多器官功能衰竭 4例。结论 危重心脏瓣膜病的外科治疗应注重围术期处理 ,适当选择手术时机 ,合理纠正病变 。

Objective This is to summarize the experience of surgical treatment of critical cardiac valve disease and the management during perioperative period.Methods 115 patients with critical cardiac valve disease from May 1998 to September 2002 underwent valve replacement.There were 47 male and 68 female,with an age range from 16 to 75 years.Preoperative heart function 48 cases in class Ⅲ,and 67 cases in class Ⅳ.Mitral valve replacement was performed in 48 cases;Aortic valve replacement was performed in 18 cases among which additional coronary artery bypass grafting was performed in 3 cases;Both mitral and aortic valve replacement was performed in 49 cases.Associated procedures were tricuspid annuloplasty in 33 cases,tricuspid valve replacement in 1 case,left atrium thrombectomy in 22 cases,left atrium annuloplasty in 18 cases.Results Ventricular arrhythmia,low cardiac output,respiratory failure and multiple system organ failure(MSOF)were the most frequent early complications.The early death was 5 cases,the cause of mortality was ventricular arrhythmia(1 cases)and MSOF(4 cases).Conclusion Surgical treatment for critical cardiac valve disease should include following measures:emphasizing the management during perioperative period,appropriately operative chance,correcting pathological changes,strengthening the prevention and the treatment of postoperative complications.