联合瓣膜病合并巨大左室的瓣膜替换术

目的 评价联合瓣膜合并巨大左室病人瓣膜替换术的疗效。结果 １９９０年１月至１９９８年６月间共５９例联合瓣膜病变合并巨大左室病人行二尖瓣与主动脉瓣双瓣替换术，其中保留二尖瓣全或后瓣下结构２１例，行三尖瓣成形术４２例，左房折叠术１１例。结果 术后早期并发症２５例，晚期死亡４列，占２．６７％。影响手术早期疗效的主要因素是术前重度左室扩大，收缩末直径（ＥＳＤ）≥６．０ｃｍ和舒张末直径（ＥＤＤ）≥８．０ｃｍ

Multiple valve replacement in patients with giant left ventricle

Objective To evaluate the effectiveness of valvular replacement in patients with multiple valvular le-sions associated with giant left ventricle (GLV). Methods Multiple valvular operations were performed in fifty ninepatients (male 52, female 7) with GLV between Jan 1990 and June 1998. Combined mitral and aortic valve replace-ment was performed in all patients with preserved mitral subvalvular structure in 21, tricuspid valve annuloplasty in 42,and left atrium plication surgery in 11. Results The early postoperative complication and mortality rates were 42.3 %and 15.25％, respectively. The late mortality rate was 2.67 % per patient-year. For these patients, the main factorsinfluencing the early surgical results were preoperative severe left ventricular enlargement (ESD≥6.0 cm and EDD≥8.0 cm) and systolic dysfunction (EF≤40％and FS≤25％), perioperative ventricular fibrillation, postoperative lowcardiac output and multiple organal failure. And the main factors affecting long-term survival were postoperative severeventricular arrhythmia and left ventricular enlargement with depressed systolic performance. Conclusion The keypointto improve the early and late results of these kind of patients are the choice of optimum surgical timing, the propermanagement of the high risk factors mentioned above during perioperative and follow-up periods. (Shanghai Med J,2000,23:599-602)