摘要
目的探讨人工心脏瓣膜置换术后瓣周漏的治疗经验。方法分析1993年1月至2005年6月诊治的34例瓣周漏患者的临床资料，其中主动脉瓣位6例，二尖瓣位28例。9例行内科保守治疗，25例因明显贫血和（或）心功能衰竭（心衰）及内科治疗效果不好行外科手术治疗。手术直接修补瓣周漏漏口14例，另10例重新换瓣。结果保守治疗者中，2例在住院期死亡，死因分别为感染性休克、心衰；7例患者随访6～72个月，2例因心衰而死亡，余5例生活良好，超声心动图检查显示漏口无明显变化，心脏各房室无增大，心功能Ⅱ级。手术治疗者中，术中死亡1例，术后死亡3例（12％）；生存的21例患者术后随访4～132个月，1例二尖瓣和1例主动脉瓣瓣周漏修补术后瓣周漏复发，21例均生活质量良好，心功能Ⅱ级。结论对瓣周漏引起症状不严重，对血流动力学影响不明显，心功能良好的患者，可行内科保守治疗，定期随访。对有明显贫血和（或）心功能减退者，应尽早手术治疗。
Objective To study the treatment of paravalvular leakage （PVL） after cardiac valve replacement retrospectly. Methods Between 1993 and 2005, 34 patients with PVL were observed, including aortic PVL in 6 patients and mitral valve PVL in 28 patients. Twenty-five patients with severe anemia and/or heart failure were reoperated , 9 patients without severe clinical symptoms and signs had treated conservatively. Repair of PVL was carried out in 14 patients, and the other 10 patients were performed prosthetic valve replacement. Results Of 9 patients who had treated conservatively, 1 patients died of septic shock , and 1 patient died of heart failure. During 6-72 months follow-up, of the seven survivals, 2 patients died of heart failure. And the other 5 patients were in NYHA class Ⅱ. Echocardiagarphy demonstrated no obvious enlargement of the PVL and diameter of the heart. Among the 25 patients who were reoperated, the overall operative mortality was 12% （3 patients）. Twenty-one survivals were in NYHA class Ⅱ during the follow-up of 4-132 months. While a mitral valve PVL and a arotic valve PVL were diagnosed among them after the reoperation 4 years and 6 months respectively. Conclusions Patients with PVL and no severe symptoms can be treated conservatively and followed up. A more aggressive surgical treatment is recommended for patients with PVL and severe anemia and/or heart failure.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2006年第10期658-660,共3页
Chinese Journal of Surgery
关键词
心脏瓣膜
人工
手术后并发症
治疗
Heart valve prosthesis
Postoperative complications
Treatment
