重度二尖瓣狭窄伴小左室的外科治疗

目的]探讨重度二尖瓣狭窄伴小左室病人外科治疗的围术期特点。方法]对本院1990年1月至2003年4月214例风湿性心脏病二尖瓣病变行二尖瓣替换术(MVR)的病人中重度二尖瓣狭窄伴小左室36例进行回顾性分析。结果]术后死亡5例(13．9％)．明显高于同期二尖瓣狭窄非小左室病人；3例为术后严重低心排导致多脏器功能衰竭，1例为大出血．1例为急性肾功能衰竭。术后低心输出量综合征发生率为27．8％。结论]重度二尖瓣狭窄伴小左室虽然是手术的高危指标．但不是手术禁忌，术中选用较小型号的瓣膜并注意心肌保护，加强围术期处理是手术成功的关键。

Surgical Treatment of Severe Mitral Stenosis Associated with Small Left Ventricle

ObjectiveTo explore the perioperative features of surgical treatment in patients of severe mitral stenosis (SMS) associated with small left ventricle (LV). Mitral valve replacements (MVRs) were undertaken in 214 patients with rheumatic heart disease (RHD) displaying mitral valve involvement from January,1993 to April,2003.Thirty-six patients out of them belonging to SMS associated with small LV were analyzed retrospectively. Postoperative mortality was 13.9% (5/36),obviously higher than that in patients of mitral stenosis without small LV. Their causes of death were multiple organ failure induced by severe lowered cardiac output in 3 cases , massive hemorrhage in 1 case and acute renal failure in 1 case. The postoperative incidence of low cardiac output syndrome was 27.8%.Conclusions] Although SMS associated with small LV may be considered as a high risk factor for MVR, but it is not surgical contraindication. The key points of successful operation depend on the choice of smaller valves , paying attention to protection of myocardium and the intensification of perioperative management.