摘要
目的:总结重症风湿性心脏瓣膜病合并巨大左心室外科治疗经验。方法:对35例巨大左心室合并风湿性心脏瓣膜病人施行心脏瓣膜置换术。其中二尖瓣置换术5例,主动脉瓣置换术4例,主动脉瓣和二尖瓣双瓣置换术26例;同期行三尖瓣成形术21例,左房折叠术12例。结果:本组治愈34例,早期死亡1例,术后心胸比率[(0.6±0.08)∶(0.8±0.03)]、左室舒张期内径[(64.1±5.6)mm∶(79±4.8)mm]较术前明显减少(P均<0.01);左室收缩期内径[(45±7.2)mm∶(58±7.0)mm]、左房内径[(51±10)mm∶(63±12)mm]也较术前显著减少(P均<0.05)。左室射血分数、左室短轴缩短分数与术前比较无显著差异(P>0.05)。随访3个月～5年,心功能恢复Ⅰ级者21例,Ⅱ级者12例,Ⅲ级者2例。结论:巨大左心室合并风湿性心脏瓣膜病并不是手术禁忌,经充分的术前准备后仍可进行手术治疗;选择好手术时机、加强心肌保护以及围术期的处理是手术成功的关键。
Objective： To summarize the clinical experience in surgical treatment of severe rheumatic valve disease with large left ventricle. Methods： The 35 patients suffering from severe rheumatic valve disease with large left ventricle （LVEDD〉70mm, LVESD〉 50ram, EF〈0.5, FS〈0. 25） were undergoing valve replacement operation. Mitral replacement was performed in five, aortic valve replacement in four, mitral and aortic valve replacement in 26, meanwhile left atrium placation surgery in 12, and tricuspid valve annuloplasty in 21 patients. Results： The 34 patients were cured by valve replacement, one case died in early period after operation. After operation, cardiothoracic rate （C/T） [ （0.6!0.08） vs. （0.8±0.03）1 and LVEDd [ （64.1±5.6） mm vs. （79±4.8） mini significantly decreased （P〈 0.01 all）, LVESd [ （45±-7.2） mm vs. （58±7.0） mm] and LAD [ （51±10） mm vs. （63±12） mini decreased as well （P〈0.05 all） compared with before operation, . LVEF and LVFS did not significantly change between before and after operation （P〉0.05 all） . Followed up for 3 months to 5 years, Heart function （NYHA class） improved to 1 grade in 21 patients, 2 grade in 12 patients and 3 grade in two patients. Conclusion： An optimal operative opportunity, adequate preoperative preparation, satisfactory myocardial protection are key points for a successful surgical treatment of severe rheumatic valve disease with large left ventricle.
出处
《心血管康复医学杂志》
CAS
2010年第5期526-529,共4页
Chinese Journal of Cardiovascular Rehabilitation Medicine
关键词
风湿性心脏病
肥大.左心室
心脏外科手术
Rheumatic heart disease
Hypertrophy, left ventricle
Heart surgical operation
