二尖瓣闭式扩张术后的瓣膜替换术

Mitral valve replacement after mitral commissurotomy in 39 cases

目的 :总结二尖瓣闭式扩张术后行瓣膜置换术的经验。方法 :对 3 9例二尖瓣狭窄扩张术 (经皮球囊二尖瓣成形术 5例 ,闭式二尖瓣扩张分离术 3 4例 )后在低温体外循环下 ,经右房—房间隔切口行瓣膜置换术患者的资料进行总结。结果 :术后早期死亡 2例 ,余康复出院 ,心功能改善明显 ,生活质量显著提高。结论 :把握好手术时机 ,注重心肌保护 ,避免广泛游离心包粘连 ,经右房—房间隔切口显露二尖瓣以及正确的围术期处理是手术成功的关键。

Objective To retrospectively review the experience of mitral valve replacement after mitral commissurotomy in 39 cases. Methods 39 patients[male 18,female 21;average age (45.3±5.2) years old,ranging from 23 to 63] underwent mitral valve replacement (MVR)from August 1995 to November 2002,among whom 5 suffered from restenosis after percutaneous balloon mitral valvoplasty(PBMV)and 34 after closed mitral commissurotomy(CMC). 5 cases underwent emergent operation and the rest did selectively. The average interval from PBMV or CMC to MVR was (11.2±4.9) years. All of the operations were performed under hypothermia and cardiopulmonary bypass(CPB) through right atrial and atrial septal incisions. Results The early-stage postoperative mortality was 5.1%(2/39). 1 case died of low cardiac output syndrome and 1 of left atrium rupture in this group. The cardiac function status in the survivors was significantly improved. Conclusions The factors decreasing hospital mortality of reoperation on mitral valve include: avoiding too much dissection of the adherence pericardium during operation; exposing the mitral valve through right atrial and atrial septal incisions; excellent myocardial protection; prompt and correct perioperative managements of the patients.