摘要
目的探讨二尖瓣、主动脉瓣、三尖瓣联合瓣膜病变并发心房纤颤外科治疗的可行性。方法中、低温(23℃~27℃)体外循环下手术。血液中度稀释,主动脉根部或左右冠状动脉口灌注心脏冷停跳液,心包腔内放置冰屑持续心肌降温。待心脏停跳后,切开右房及房间隔行二尖瓣替换,然后于主动脉根部横功口替换主动脉瓣,根据三尖瓣返流程度和瓣环的大小放置相匹配的成形环(圆形或C型),缝合固定成形,以矫治三尖瓣关闭不全。均采用美墩利公司生产的单极射频消融笔射频消融去除房颤。结果 23例联合瓣膜病变患者皆行二尖瓣、主动脉瓣替换、三尖瓣成形,22例行房颤射频消融术。手术顺利,平均住院时间19.6d,康复出院。术后随访3~38个月,心功能由手术前的Ⅲ级、Ⅳ级恢复到Ⅰ级者20例、Ⅱ级者2例、Ⅲ级者1例。彩色多普勒复查显示:机械瓣功能良好,无瓣周漏,三尖瓣成形后返流消失者16例,转为轻度返流者4例,中度返流者3例。结论对二尖瓣、主动脉瓣与三尖瓣联合瓣膜病变合并心房纤颤的患者,只要手术时机选择适当,认真做好围术期的处理,积极实施外科手术治疗是切实可行的,仍可取得令人满意的临床效果。
Objective To explore the feasible surgical treatment for the combined valvular disease of mitral valve, aortic valve and tricuspid valve complicated with atrial fibrillation.Methods The operations were performed under middle hypothermia cardiopulmonary bypass.After moderate blood dilution, arteryperfusion fluid of cardiac arrest was used in the opening of aortic root or the left and right coronary arteries, and t ice chips were placed in the pericardial cavity to cool myocardium.After the cardiac arrest, the right atrial and atrial septal were cut open to replace the mitral valve and then to replace the aortic valve through the aortic root transverse incision.According to the degree of regurgitation and the size of the valve ring, the tricuspid valve was formed by placing the round or C-type loop to correct the tricuspid insufficiency.The radiofrequency ablation was got by using a single pole radio frequency ablation pen produced by Medtronic Inc.to treat atrial fibrillation.Results 23 patients underwent replacement of mitral, aortic and tricuspid valves and 22 cases received radiofrequency ablation for atrial fibrillation.The operations were successful, the average hospital stay was 19.6 days, and all cases recovered and were discharged from the hospital.The postoperative follow-up surveys lasted 3-38 months.The heart functions returned from the preoperative Grade III and Grade IV to Grade I level （20 cases）, Grade II （l2 cases） and Grade III （l case）.The Color Doppler recheck showed that the mechanical valve functions were good and no valve leakage occurred The tricuspid regurgitation disappeared after tricuspid valvuloplasty in 16 cases, mild reflux appeared in 4 cases and moderate reflux in 3 cases.Conclusion Surgical treatment for the combined valvular disease of mitral valve, aortic valve and tricuspid valve
出处
《山东医学高等专科学校学报》
2017年第3期191-194,共4页
Journal of Shandong Medical College
关键词
体外循环
瓣膜替换
心房纤颤
三尖瓣成形
肺动脉高压
Cardiopulmonary bypass
Valve replacement
Atrial fibrillation
Tricuspid valvuloplasty
Pulmonary hypertension
