二尖瓣-主动脉瓣置换术近期和远期效果的评价

目的 :评价单瓣与双瓣置换术的近期与远期效果。方法 :70例风湿性心脏病人采用国产上海碟瓣行机械瓣置换术 ,其中单纯行二尖瓣 (MV)置换术者 47例 ,二尖瓣加主动脉瓣 (AV)双瓣置换术者 2 3例。生存者 10 0 %随访 1～ 7年 (平均 4.76± 1.7年 )。结果 :院内死亡 4例 ,死亡率为 5 .71%。随访中死亡 2例 ,远期死亡率为 0 .63 %人·年。 7年生存率为 95 .69% ,10年生存率为 93 .89%。 94.0 0 %术后心功能均改善Ⅰ～Ⅱ级。结论 :房颤 (Af)并Ⅱ度房室传导阻滞的病人应暂缓手术 ;国产上海碟瓣有良好的血流动力学特性 ;只要处理恰当 ,双瓣手术的危险性不比单瓣手术的危险性高。

Early and long-term results of mitral and aortic valve replacement: Follow-up to seven years

Objective:To evaluate the early and long term results of one and two valves replacement.Method:Seventy patients with rheumatic heart disease underwent mechanical valve replacement at our hospital from 1994～2000.Among them,forty seven patients underwent mitral valve replacement singly,twenty three patients underwent mitral and aortic valve replacement.The mechanical valve we used were dish valve that made in Shanghai.The follow up was 100% completed from one to seven years ( mean 4.76±1.7 years ). Results:Four cases died , the hospital mortality was 5.71%,and two cases died during the follow up , the long term mortality was 0.63% pt yr , the survival rate of seven years was 95.69%.94.00% patients had improved postoperative functional class Ⅰ or Ⅱin our series.Conclusion:The patients of atrial fibrillation with Ⅱ artial ventricular block (Ⅱ AVB) should not be undergone operation immediately.Excellent hymodynamic performance of mechanical valve of Shanghai has been reported by many investigators.According to our experiences,if the management was appropriate,mitral valve replacement did not result in a significantly lower risk than double heart valve replacement.