再次人工心脏瓣膜置换术临床研究

目的研究再次人工心脏瓣膜置换的病因、手术适应证、手术技巧及高危因素。方法回顾性分析了2000年3月～2006年7月所行的18例再次人工心脏瓣膜置换术，年龄21～69岁，平均45岁，4例为急性起病，14例为慢性发病。术前心功能（NYHA）Ⅱ级2例，Ⅲ级7例，Ⅳ级9例。再次换瓣的病因有人工生物瓣衰败7例，瓣周漏5例，左心房血栓形成3例，主动脉瓣叶上血栓形成1例，感染性心内膜炎致主动脉瓣架边缘菌栓2例。再次手术共植入人工瓣膜20枚，3例选用生物瓣，另外15例共17枚瓣膜采用机械瓣。结果因术后出现严重低心排综合征及多脏器功能衰竭死亡2例，均为术前心功能Ⅳ级者，16例痊愈出院。随诊4个月～6a，心功能恢复良好。结论对于人工瓣膜置换术后瓣膜功能障碍要及时处理，有再手术指征者果断手术。只要术中谨慎操作，围术期严密监护，再次手术也是安全的。

Clinical Analyzing on Heart Valve Re - replacement

Objective Heart valve re-replacement has become a quite common procedure.The study is to determine the pathogensis of prosthetic valve malfunction,indications for heart valve re-replacement and skills in it.Methods From March 2000 to July 2006,18 heart valve re-replacements were performed for prosthetic valve malfunction.The age was in range from 21 years to 69 years(mean 45 years),4 cases acute attack,14 cases chronic.Mean time interval between initial valve replacement and re-replacement was 5.3 years.Before re-replacement,2 patients are in New York Heart Association(NYHA) functional class II,7 patients are in class III and 9 patients are in class IV.Degeneration of bioprosthes is occurred in 7 patients,paravalvular leak in 5 patients, atrial thrombosis in 3,thrombosis on leaflet of mechanical artic valve in 1 and infective endocarditis in 2.There were 20 prosthetic valves used in the re-replacements.3 patients used bioprosthetic valves,other 15 patients used 17 mechanical valves.Results There were 2 death in the 18 patients in hospital,they were NYHA class IV patients,16 patients recovered.The follow-up was from 4 month to 6 years,and there was no late death,all cardiac functions were improved to well.Conclusion Patients with prosthetic valve replacement should be regularly and carefully follow-up.Once valve dysfunction appears, re-replacement should be resorted to and appropriate preoperative preparations should be made for patients with poor cardiac function.The main determinants of deaths are related to the degree of patients' cardiac function rather than to inherent technical factors of re-replacement.