主动脉瓣及二尖瓣双瓣膜置换术的临床经验

总结主动脉瓣及二尖瓣置换术的临床经验，５０例风湿性主动脉瓣及二尖瓣行双瓣置换术，心功能Ⅱ级６例，Ⅲ级３２例，Ⅳ级１２例，所有病例术中均行左心耳结扎，同期行冠状动脉旁路移植术（ＣＡＢＧ）１例，主动脉环扩大２例，三尖瓣成形１１例，左房折叠８例，术后早期死亡３例（６％），死亡原因为心肌保护不当，消化道大出血及脑出血各１例，其余４７例随访４个月至６年，心功能恢复至Ｉ～Ⅱ级。提高双瓣膜置换术手术疗效的关键；

CLINICAL EXPERIENCE OF DOUBLE VALVE REPLACEMENT

The aim of this paper was to report the clinical experience of double valve(mitral and aortic) replacement (DVR).Fifty patients with rheumatic mitral and aortic valve diseases underwent double valve replacement with prosthetic valves under cardiopulmonary bypass.The preoperative heart function was class II in 6,class III in 32 and class IV in 12.Accessory procedures performed during DVR included CABG in 1,aortic annular enlargement in 2,left atrial appendage ligation in 50,left atrial plication in 8,tricuspid annuloplasty in 11.Hospital mortality was 6%(3/50),in which unfavourable myocardial protection was in 1,and gastric and cereberal hemorrhage were in two others.Fourty seven cases were followed up for 4 months to 6 years and heart funciton was recovered to I II class.To enhance the surgical outcome for DVR,modification of sugical techniques and management of giant left atrium and functional tricuspid insuficiency need to be concerned.Furthermore,tepid blood cardioplegia may be benifitial for DVR in myocardial protection.