风湿性心脏瓣膜病合并左房混合血栓的外科治疗

Surgical treatment for rheumatic heart valvular disease combined with left atrial mixed thrombus

目的:探讨风湿性心脏瓣膜病合并左房混合血栓的外科治疗的经验.方法:1999年1月至2003年1月间我院胸心外科手术治疗风湿性心脏瓣膜病合并左房混合血栓患者25例.所有患者均行左房混合血栓清除术,其中同期行二尖瓣机械瓣置换术(MVR)19例,二尖瓣及主动脉瓣机械瓣置换术(DVR)6例.结果:术后24例生存,1例围手术期因肝、肾功能衰竭死亡,病死率为4%(1/25).生存病例术后随访3～32个月,心功能均有不同程度改善,无脑、肾、四肢动脉栓塞发生.结论:对风心病合并左房混合血栓的患者,术前诊断准确、术中操作轻柔和完全清除血栓等围手术期处理可避免在围手术期及远期出现脑、肾和四肢动脉栓塞,降低病死率.

Objective : To summarize the experience on surgical management of left atrial mixed thrombus in patients with rheumatic heart valve disease. Methods :Totally 25 patients with rheumatic heart valve disease combined with left atrial mixed thrombus were treated surgically from Jan. 1999 to Jan. 2003. The elimination of left atrial thrombus was performed in all patients. Results: One patient died of hepatic and renal failure postoperatively with a mortality of 4% (1/25). The survivors were followed up for 3-32 months. Their heart function was improved and no arterial membolization of brain, kidney and limbs was found. Conclusion: Careful perioperative management including correct diagnosis and complete elimination of mixed thrombus, can avoid the arterial embolization and decrease the mortality.