摘要
对29例二尖瓣关闭不全伴巨大左室病人施行二尖瓣置换术,其中19例保留了二尖瓣全部的或后瓣的腱素与乳头肌,11例同期施行三尖瓣环缩术。术后早期出现心、肺、肾等重要器官衰竭10例,其中死亡2例(6.9％)。晚期死亡1例。余26例心功能Ⅰ级22例,Ⅱ级4例。长期生存者术后6～12个月行超声心动图复查,提示左心功能有显著改善。我们认为,二尖瓣关闭不全伴巨大左室,术前左室短轴舒张末内径>80mm,收缩末内径>60mm,短轴内径缩短率<0.25者,属高危病人,其术后并发症发生率及死亡率均明显增高。对二尖瓣关闭不全伴巨大左室病人手术方法的改进及围术期处理的特点进行了讨论。
29 patients with mitral insufficiency associated with giant left ventricle (left ventricular end-diameter 70mm) were operated on for mitral valve replacement in our hospital from Jan 1987 to Aug 1992. Preoperative EDD was 79.3(70.4-98.3)mm, ESD 57.9(51.0-74.3)mm, EF 0.54 (0.44-0.67), FS 0.27(0.18-0.35). Cardiac/thoracic ratio was 0.66 to 0.98. NYHA heart function class Ⅲ was in 7 and class Ⅳ in 22. Among them, 11 patients had more than moderately functional tricuspid insufficiency. Concomitantly all 29 patients had MVR, and mitral appratus was preservated in 19 cases and tricuspid valvuloplasty was performed in 11. Early postoperative complications found in 10 patients were low cardiac output syndromes, respiratory failure, renal failure and MOF. Death occured within 30 days in 2(6.9%) patients. There was 1 late death. Of 26 long term survivors, 22 were NYHA class I, 4 being class Ⅱ. The results of echo-cardiographic reexaminations for long term survivors showed that left ventricular functions improved significantly 6 to 12 months postoperatively. The authers' conclusion is that preoperative patients with EDD>80mm, ESD>60mm, and FS<0.25 were identified as the high risk group of patients with mitral insufficiency, and early postoperative complications and mortality of them increased significantly. The optimal operative methods and features of peroperative management for mitral insufficiency with giant left ventricle were discussed.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
1993年第2期97-100,共4页
Medical Journal of Chinese People's Liberation Army
关键词
二尖瓣
关闭不全
二尖瓣置换
Mitral insufficiency
Giant left ventricle
Mitral valve replacement
