摘要
目的：分析风湿性二尖瓣、主动脉瓣与三尖瓣联合病变外科治疗的结果。方法：近８年间，对３８０例风湿性二尖瓣、主动脉瓣与三尖瓣联合病变病人施行外科治疗，其中３４６例为二尖瓣与主动脉病变合并三尖瓣功能性关闭不全；３４例合并三尖瓣器质性病变。心功能ＩＩＩ、ＩＶ级者占９５．４０％。二尖瓣与主动脉瓣均作瓣膜替换术，三尖瓣功能性关闭不全行ＤｅＶｅｇａ或Ｋａｙ环缩术；器质性病变行交界切开与瓣环成形术。结果：早期死亡３９例（１０．２６％）；近４年来，死亡率已下降为２．１０％。平均随访时间４．４病人·年，５年生存率为８０．７２％。结论：风湿性三瓣膜病变常引起左、右心功能不全，并发肺动脉高压与体循环静脉系统淤血，引起重要脏器功能障碍。因此，加强围术期处理，积极施行三尖瓣功能关闭不全瓣环成形术，对改善手术疗效与晚期效果尤为重要。
Aim:To evaluate the clinical outcome of surgical interventions of combined mitral,aortic and tricuspid valvular lesions with rheumatic etiology.Clinical material and method:Three hundred and eighty patients with combined mitral,aortic and tricuspid valvular lesions were treated surgically from 1990 to 1998.Among them,346 patients had rheumatic mitral and aortic valve lesions associated with functional tricuspid regurgitation and rheumatic fever involving the triple valves in 34.The heart function was class III to IV in 95.4% of patients(NYHA).Mitral valve and aortic replacements were performed in all patients.DeVega or Kay annuloplasty was carried out in patients with functional tricuspid regurgitation.Commissurotomy and DeVega annuloplasty were performed in those with organic tricuspid stenosis.Results:There were 39 early operative deaths with a mortality rate of 10.26%.During the recent four years,the operative mortality rate was significantly reduced to 2.10%.The mean follow up was 4.4 patient·years.Five year survival rate was 80.72%.Conclusion:The patients with rheumatic triple valvular diseases are often associated with both left and right ventricular dysfunction,pulmonary hypertension and systemic venous stasis which further lead to obvious dysfunction of the other vital organs.Therefore,the proper perioperative management and carefully correction of tricuspid regurgitation with annuloplasty are important factors influencing surgical results.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
1999年第2期68-71,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
二尖瓣病变
主动脉瓣病变
三尖瓣病变
治疗
Combined lesions of triple valves Double valve replacement Tricuspid annuloplasty
