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时间:2017-12-10
《人工心脏瓣膜瓣周漏34例临床分析》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、维普资讯http://www.cqvip.com-658·2006年5月第44器第l0期ChinJSurg.May2006,Vo1.44,No.10.胸心血管外科.人工心脏瓣膜瓣周漏34例临床分析王坚刚孟旭郑斯宏侯晓彤【摘要】目的探讨人工心脏瓣膜置换术后瓣周漏的治疗经验。方法分析1993年1月至2005年6月诊治的34例瓣周漏患者的临床资料,其中主动脉瓣位6例,二尖瓣位28例。9例行内科保守治疗,25例因明显贫血和(或)心功能衰竭(心衰)及内科治疗效果不好行外科手术治疗。手术直接修补瓣周漏漏口l4例,另l0例重新换瓣。结果保守治疗者中,2例在住
2、院期死亡,死因分别为感染性休克、心衰;7例患者随访6~72个月,2例因心衰而死亡,余5例生活良好,超声心动图检查显示漏El无明显变化,心脏各房室无增大,心功能Ⅱ级。手术治疗者中,术中死亡1例,术后死亡3例(12%);生存的21例患者术后随访4~132个月,1例二尖瓣和1例主动脉瓣瓣周漏修补术后瓣周漏复发,2l例均生活质量良好,心功能Ⅱ级。结论对瓣周漏引起症状不严重,对血流动力学影响不明显,心功能良好的患者,可行内科保守治疗,定期随访。对有明显贫血和(或)心功能减退者,应尽早手术治疗。【关键词】心脏瓣膜,人工;手术后并发症;治疗Clinicala
3、nalysisin34gasesofparavalvularleakageaftervalvereplacementⅣGJian.gang.MENGXu。zHENGSi—hong。HoUXiao—tong.DepartmentofCardiacSurgery.AnzhenHospitaloftheCapitalUniversityofMedicine。Betng100029ChinaCorrespondingauthor:WANGJian—gnng,Email:wangfiangang7545@126.con【Abstract】Objectiv
4、eTostudythetreatmentofparavalvularleakage(PVL)aftercardiacvalvereplacementretrospectly.MethodsBetween1993and2005,34patientswithPVLwereobserved.includingaorticPVLin6patientsandmitralvalvePVLin28patients.Twenty.fivepatientswithsevereanemiaand/orheartfailurewerereoperated.9pati
5、entswithoutsevereclinicalsymptomsandsignshadtreatedconservatively.RepairofPVLwascarriedoutin14patients,andtheother10patientswerepedonnedprostheticvalvereplacement.ResultsOf9patientswhohadtreatedconservatively.1patientsdiedofsepticshock,andlpatientdiedofheartfailure.During6—7
6、2monthsfollow.up,ofthesevensurvivals,2patientsdiedofheartfailure.Andtheother5patientswereinNYHAclassII.EchocardiagarphydemonstratednoobviousenlargementofthePVLanddiameteroftheheart.Amongthe25patientswhowerereoperated.theoveralloperativemortalitywas12%(3patients).Twenty—onesu
7、rvivalswereinNYHAclassIIduringthefollow—upof4一l32months.WhileamitralvalvePVLandaaroticvalvePVLwerediagnosedginongthemafterthereoperation4yearsand6monthsrespectively.ConclusionsPatientswithPVLandnoseveresymptomscanbetreatedconservativelyandfollowedup.Amoreaggressivesur~"caltr
8、eatmentisrecommendedforpatientswithPVLandsevereanemiaand/orheartfailure.【Ke
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