摘要
目的:探讨二尖瓣置换术后左心室破裂的原因及外科处理策略。方法:回顾分析9例二尖瓣置换术后发生左心室破裂的诊治经验。结果:根据左心室破裂时间分类,延迟破裂2例,早期破裂7例。其中Ⅰ型3例,Ⅱ型4例,Ⅲ型2例。手术抢救成功2例,死亡7例。结论:女性、高龄、病理改变以二尖瓣狭窄为主、小左心室和体重过低等是左心室破裂的危险因素。过多去除二尖瓣环上的钙化斑块;置换瓣膜型号过大;瓣环处缝合进针过深;对乳头肌牵拉过度或者切除过多;心肌血肿以等因素增加了左心室破裂的危险性。一旦发生,应迅速建立体外循环,积极抢救,但术中、术后采取有效的预防措施更为重要,包括重视高龄妇女、小左心室,提高手术操作技术,选用合适的人工瓣膜及其型号,术后减轻心脏前、后负荷(控制血压)等。
Objective：To evaluate the causes,prevention and treatment strategy of left ventricular rupture after mitral valve replacement.Method：The diagnostic and therapeutic measure of 9patients,with left ventricle rupture after the mitral valve replacement in our hospital,between 2001 and 2013,were retrospectively analyzed.Result：Rupture probably occurs after endocardial damage to a thin myocardium that has lost the Internal buttress of the subvalvular apparatus.With the rise in intraventricular pressure at the end of bypass,blood dissects into the myocardium,resulting in a large haematoma and eventual rupture.According to the onset of ruptures,there were 2 cases of delayed rupture which occurred at several hours till days post operation after the patients had been back in the ICU;7 cases of early rupture,which occurred at the early stage of surgery,while the patient was still in the operation room.The types of the ruptures were identified by operation or necropsy as 3 cases of typeⅠ,4 cases of typeⅡ,and 2 cases of typeⅢ.Two patients were saved after emergency treatment,and 7 died.Conclusion：It is difficult to repair left ventricle rupture,but effective prevention from onset can decrease its occurrence.The risk factors for left ventricular ruptures including female,advanced age,pathological changes characterized by mitral stenosis,small left ventricle,and low weigh.The following actions increase the risk of left ventricular rupture：aggressive removal of calcification at the mitral valve;undue selection and replacement of mitral valve prostheses;large size of prosthetic valve;deep sutures at the valve ring;aggressive traction or removal of papillary muscle and haematoma.Once left ventricular rupture occurs,immediate cardiopulmonary bypass should be established as soon as possible.Intraoperative preventive measures are more important.This include special care for old women and small left ventricle,improving the operative skill technique,selection of adequate artificial valve and size,and reduction anterior a
出处
《临床急诊杂志》
CAS
2015年第3期183-185,共3页
Journal of Clinical Emergency
关键词
二尖瓣
心脏瓣膜假体植入
心室心脏破裂
mitral valve
heart valve prosthesis implantation
ventricular cardiac rupture
