摘要
本文对308例人工心脏瓣膜置换术病例进行临床分析。其中置换生物瓣119例,机械瓣189例,患有慢性风湿性瓣膜病291例,先天性心脏病5例,二尖瓣粘液样变12例。术后发生严重并发症40例,早期死亡26例(8.4%)。随访175例,晚期死亡17例(9.7%),疗效差者4例(0.2%),其余病例心功能都有明显改善,其中3例足月妊娠顺产。文中对病例选择、手术时机的掌握以及人工瓣膜的选择等问题进行了分析和讨论。
From 1978 to 1989, 308 (148 males, 160 females) patients aged 5-63 years had prosthetic valve replacement in our institute. Among them, 288 cases suffered from chronic rheumatic valvular disease with deterioration of replaced bioprosthetic valve in 5 cases and mitral restenosis following close mitral commissurotomy in 14 cases, 4 cases had congenital valve malformation, 14 cases had mucoid degeneration and 2 cases suffered from endocarditis. According to the NYHA classification of cardiac function, 102 cases were of class Ⅱ, 200 cases of class Ⅲ, 6 cases of class Ⅳ. The maximum and minimum cardiothoracic ratios were 0.89 and 0.58 respectively, with an average of 0.69.4 cases had TVR, 228 cases MVR, 20 cases AVR,53 cases MVR and AVB, 2 cases MVR an TVR and 1 case DVR. Bioprosthetic valve was used in 119 cases with Hancock valve in 5 cases and mechanical valve in 189 cases with Bjork Shiley valve in 3 cases and St. Jude valve in 5 cases. 40 cases(13%)had serious complications after the operation, 26 cases (8.4%) died in the hospital while 17 cases(9.7%) died at late stage. Follow up of 175 cases (61%) revealed bioprosthetic valve deterioration in 12 cases (16%), thromboembolism in 4 cases (3.6%) after mechanical valve replacement. 102 cases (69%) had cardiac function restoration to class Ⅰ after operation (69%), 46 cases (31%) to class Ⅱ. The authors emphasize that preoperative preparation, selection of patients and opportune moment of prosthetic valve replacement are important.
出处
《中国循环杂志》
CSCD
1992年第1期7-9,共3页
Chinese Circulation Journal
