瓣膜性心脏病伴缺血性心脏病的外科治疗

Surgical management of valvular heart diseasecombined with ischemic heart disease

目的 :总结瓣膜性心脏病伴缺血性心脏病手术治疗的早期效果和经验 ,以期提高疗效。方法 :11例患者中 ,行主动脉瓣置换术 4例 ,二尖瓣置换术 2例 ,二尖瓣和主动脉瓣双瓣置换术 1例 ,主动脉带瓣管道置换 2例 ,二尖瓣成形术 1例和三尖瓣成形术 1例 ;搭 1支桥 4例 ,搭 2支桥 1例 ,3支桥 3例 ,4支桥 3例 ,平均 (2 .5±1.3)支。结果 :11例无手术早期死亡 ,痊愈出院 ;随访 2～ 16 (平均 6 .3)个月 ,心绞痛症状消失 ,心功能明显改善。结论 :对年龄 >5 0岁瓣膜病患者或具有冠心病高危因素患者 ,应行冠状动脉造影检查 ;彻底纠正心脏病变 ,加强心肌保护 ;妥善处理术后并发症 。

Objective:To review the experience of the simultaneous valvular surgery with coronary artery bypass grafting (CABG). Methods:Combined valvular and myocardial revascularization operations were performed in 11 patients, 4 aortic valves and 2 mitral valves and 1 double valve were replaced and valvular plasty was done in 2 patients. Cabrol technique was used in 2 patients with a composite valve graft, the stenosis of left coronary arterial ostia or right coronary arterial ostia were found were found, emergency CABG were performed. The one graft was done in 4 patients, two graft in 1 patient, and three graft in 3 and four graft in 3. The average number of grafts was 2.5 .Results:No patients died of operation. All patients were discharged and associated with improved heart function. Conclusion:For patients with valvular heart disease,older than 50 years,or have high risk factor for ischemic heart disease,coronary angiography is necessary. Combined valvular and myocardial revascularization operations should be simultaneously performed.