心瓣膜病变合并巨大左心房的外科治疗

Surgical treatment of valvular disease combined with giant left atrium

目的 报道合并巨大左心房瓣膜病变的外科治疗效果。方法 在同期 667例瓣膜外科病例中合并巨大左心房 84例 ( 11% ) ,男 3 3例 ,女 5 1例 ,年龄 19～ 5 7( 4 6.7± 15 .2 )岁。最大左心房横径 ( 80 .3± 17.5 )mm( 70～ 15 0mm)。全部患者行瓣膜置换术 ,其中 ,主动脉瓣与二尖瓣双瓣膜置换术 12例 ,二尖瓣置换术 72例 ,同期行三尖瓣环缩成形术 42例 ,左心房血栓清出 13例。本组 84例患者均作平行二尖瓣环的左心房折叠 ,同时还行左房顶折叠 19例 ,左心耳结扎 14例 ,切除右侧部分左房 4例 ,折叠房间隔 18例。结果 主要并发症为再次开胸止血或解除心包填塞 6例 ,低心输出综合征 4例 ,呼吸衰竭 2例 ,肝脏功能衰竭 2例 ;手术早期死亡 5例 (死亡率 5 .95 % ) ,其中室性心律紊乱 2例 ,呼吸衰竭 2例 ,低心输出综合征 1例 ,其余均痊愈出院。术后随访 1年 ,左心房最大径 ( 5 4.6± 16.1)mm ,恢复良好 ,心功能稳定。结论 合并巨大左心房瓣膜病变患者 ,在行瓣膜置换的同时 ,术中根据左心房扩大方向合理进行折叠 ,疗效良好。

Objective To evaluate the efficacy of surgical treatment of valvular disease combined with giant left atrium. Methods Valvular replacement (VR) and left atrial plication (LAP) were performed on 84 cases (male: 33, female: 51, age range: 19-57 years old, average: 46.7±15.2 years old) associated with giant left atrium out of 667 cases with valvular disease. The VR procedure including mitral valvular replacement was performed on 72 cases and double valvular replacement on 12 cases. Meanwhile, tricuspid plication was performed on 42 cases and removal of thrombi of left atrium on 13 cases. The posteroinferior wall of left atrium was plicated in a semilunar fashion from the upper edge of the left atrial appendage to the posteromedial area of the mitral valve in all patients. Immediately after this, half superior plication was done in 19 cases and sutured left atrial appendage in 14 cases. Besides, right side plication was performed on 4 cases and plicated atrial septum on 18 cases. Results The common postoperative complications included reoperation to treat postoperative bleeding or removal of cardiac tamponade in 6 cases, low cardiac output syndrome in 4 cases, pulmonary failure in 2 cases and hepatic failure in 2 cases. The early operative deaths occurred in 5 cases (5.95%)(including 1 case of death of low cardiac output syndrome, 2 cases of ventricular arrhythmia and 2 cases of pulmonary failure. The others were cured. The mean left atrial diameter decreased to (54.6±16.1) mm and the left atrium recovered well after a follow up of 1 year. Conclusion Reasonable plication of the giant left atrium when performing valvular replacement is an efficient measure for the treatment of valvular disease combined with giant left atrium.