巨大左室瓣膜置换术围手术期处理策略

目的 探讨巨大左室高危瓣膜置换术围术期处理及心肌保护策略。方法 回顾性分析我院1988年5月至2006年10月瓣膜置换术中左室舒张末期内径（LVEDD）≥65mm的39例患者病历资料。结果 术后发生低心排综合征14例,肾功能衰竭5例,心律紊乱4例,近期死亡12例（30.08%）。结论 对巨大左室瓣膜置换术重视对低心排综合征的围术期处理和良好的心肌保护是提高手术疗效的关键措施,对左室特别巨大者的手术选择应谨慎。

Perioperative management of giant valve replacement in left ventricle

Objective To discuss the key points of myocardial protection in valve replacement for high-risk patients complicated with extremely dilated left ventricle. Methods From May 1988 to Oct. 2006, 39 cases of LVEDD more than 65mm were identified, and the detailed data of these cases were then analyzed. Results Out of the 39 (15.3%) cases, 14 had low cardiac output syndrome after operation, 5 renal failures, 4 cardiac dysrhythmia, and 12 deaths. Conclusion Perioperative management of low heart output syndrome and myocardial protection are crucial for improving the postoperative survival in valve replacement for patients with giant left ventricle. Surgical intervention for patients with extremely dilated left ventricular (LVEDD of 90mm) should cautiously be implemented.