摘要
目的:探讨三尖瓣病变的不同手术方法和术后长期疗效。方法:1979年7月至1998年6月施行三尖瓣病变外科手术51例中,三尖瓣病变中有三尖瓣下移畸形33例,三尖瓣发育不全10例,感染性三尖瓣内膜炎3例,外伤性三尖瓣关闭不全、人工瓣膜功能异常各2例和Uhl’s病1例。51例中,瓣膜替换术37例,瓣膜成形术14例。附加手术有房缺修补术、室缺修补术、房化心室折叠术和缝补术。结果:住院死亡5例,死亡率为9.8％。死亡病例中3例为低心排综合征,2例气管套管并发症。长期随访生物瓣膜死亡4例,为心力衰竭、心律失常;机械瓣死亡1例,为瓣膜栓塞;瓣膜成形术14例无死亡,心功能明显改善。讨论:超声多普勒可明确诊断三尖瓣病变,三维超声可了解瓣叶、瓣下结构和瓣叶下移程度。病变中—重度、瓣叶发育较好、前瓣叶足够大小可施行瓣膜成形术。瓣膜发育不全、严重关闭不全可施行瓣膜替换术。成形手术疗效好,无瓣膜替换术潜在并发症。瓣膜成形术尽可能作为首选手术方案。
Object: To study tricuspid valve diseases' different operational methods and long term result. Method; From July 1979 to June 1998, tricuspid valve operation had been performed in 51 patients at the institute. The tricuspid lesions included Ebstein's anomaly in 33 cases, mal - development in 10, baterical endocarditis in 3, tricuspid valve trauma and bioprosthetic valves malfunction in 2 respectively, Uhl's disease in 1. Operations included tricuspid valve replacement in 37 and tricuspid valve reconstruction in 14 (using annuloplasty of the tricuspid valve). Result: Five patients died postoperatively with and operative mortality of 9. 8%, four late deaths occurred at their discharge from the hospital and died of low cardiac output syndrome, thrombo-endolism of valve and cardiac failure. Conclusions: The availability of three dimensional Doppler can detect tricuspid valve diseases. Mild valve disease can do repair operation but severe valve disease must replacement valve. Repair operation was first methods.
关键词
三尖瓣病变
瓣膜成形术
瓣膜替换
疗效
tricuspjd valve disease repair valve tricuspid replacement
