二尖瓣置换术后远期再行主动脉瓣置换术临床分析
发布时间：2019-01-06 19:51
【摘要】：目的分析二尖瓣置换术后远期再行主动脉瓣置换术的原因、诊疗及疗效,探讨二尖瓣置换术后再行主动脉瓣置换术的手术经验、围术期处理,为临床诊疗提供参考及借鉴。方法回顾性分析自2008年1月1日至2014年12月31日期间就诊福建医科大学附属协和医院心脏外科55例曾行二尖瓣机械瓣置换术史因再发主动脉瓣膜病变而入院接受主动脉瓣置换术的患者资料,其中男21例、女34例,年龄(50.6±7.0)岁,距离首次心脏手术时间15.4±5.4年,所行手术包括主动脉瓣置换术(AVR)51例,双瓣置换术(DVR)4例,同期行三尖瓣成形术10例,同期行左房折叠1例。瓣膜全部为双叶机械瓣。治疗前后参照纽约心脏病协会(NYHA)心功能标准对患者进行心功能评级。对所有出院患者进行门诊复查和电话随访。结果二尖瓣置换术后再发主动脉瓣病变而需行主动脉瓣置换术的主要原因包括主动脉瓣风湿性病变加重(70.90%)、退行性主动脉瓣病变(25.50%)、感染性心内膜炎赘生物形成(3.60%)。住院期间死亡2例,死亡原因为多脏器功能衰竭,围手术期死亡率3.64%。非死亡病例中ICU监护时间1-7d,平均2.4±1.1d,住院时间10-44d,平均住院日20.5±10.1d。术后发生并发症者25例(45.5%),术后平均随访时间30月,随访期间无死亡,病人临床症状缓解明显,心功能得到一定程度恢复,其中心功能I级者11例,心功能II级者32例,心功能III级者10例。术前术后彩色超声心动图检查部分指标对比示:术后1周即可发现LVEDD和LA较术前明显回缩(P0.05),而LVEF、LVFS、心功能分级手术前后差异均无显著性(P0.05),出院后3月LVEDD、LA、LVEF、LVFS、LVFS、心功能分级恢复程度显著(P0.05)。结论1、主动脉瓣风湿性病变加重、退行性主动脉瓣病变、感染性心内膜炎赘生物形成这三方面是二尖瓣置换术后再发主动脉瓣病变而需行主动脉瓣置换术的主要原因。2、重视术前高危因素的存在、术前注意改善心功能、选择正确的手术时 机、术中注意心肌保护、合理的手术方法及适当的围手术期治疗,二尖瓣置换术后再行主动脉瓣置换能取得良好的手术效果。3、术后应做好出院指导及随访等工作,二尖瓣置换术后远期再行主动脉瓣置换术近期疗效显著,但远期疗效有待进一步研究。
[Abstract]:Objective to analyze the causes, diagnosis and curative effect of aortic valve replacement after mitral valve replacement, and to discuss the experience and treatment of aortic valve replacement after mitral valve replacement, so as to provide reference for clinical diagnosis and treatment. Methods from January 1, 2008 to December 31, 2014, 55 patients who had undergone mechanical mitral valve replacement with recurrent aortic valve disease were retrospectively analyzed. Data of patients undergoing aortic valve replacement, There were 21 males and 34 females, aged (50.6 卤7.0) years, who were 15.4 卤5.4 years from the first cardiac surgery. The operation included aortic valve replacement (AVR) in 51 cases, double valve replacement in (DVR) (4 cases), aortic valve replacement (AVR) in 51 cases and double valve replacement (DVR) in 4 cases. Tricuspid valvuloplasty was performed in 10 cases and left atrial folding in 1 case at the same time. The valves are all double-lobed mechanical valves. Cardiac function was rated according to the New York Heart Association (NYHA) cardiac function criteria before and after treatment. All discharged patients were reviewed by outpatient and followed up by telephone. Results the main causes of aortic valve replacement after mitral valve replacement were the aggravation of aortic valve rheumatic disease (70.90%) and degenerative aortic valve disease (25.50%). Neoplasm formation in infective endocarditis (3.60%). Two cases died during hospitalization, the cause of death was multiple organ failure, the perioperative mortality was 3.64%. The monitoring time of ICU was 1 ~ 7 days (average 2.4 卤1.1 days), the hospitalization time was 10-44 days, and the average hospitalization days were 20.5 卤10.1 days. The postoperative complications occurred in 25 cases (45.5%). The average follow-up time was 30 months. There was no death during the follow-up period. The clinical symptoms of the patients were obviously relieved and the cardiac function recovered to a certain extent. There were 32 cases of II grade and 10 cases of III grade of cardiac function. The results of color echocardiography before and after operation showed that LVEDD and LA were significantly retracted at 1 week after operation (P0.05), but there was no significant difference in LVEF,LVFS, cardiac function grading before and after operation (P0.05). Three months after discharge, the degree of LVEDD,LA,LVEF,LVFS, cardiac function grade recovered significantly (P0.05). Conclusion 1. The main causes of aortic valve replacement after mitral valve replacement are aggravated rheumatic aortic valve disease, degenerative aortic valve disease, and neoplasm formation of infective endocarditis. Attention should be paid to the existence of high risk factors before operation, to the improvement of cardiac function before operation, to the selection of correct operative timing, to the protection of myocardium during the operation, to reasonable surgical methods and to appropriate perioperative treatment, After mitral valve replacement, aortic valve replacement can get good results. 3. After mitral valve replacement, we should do a good job of discharge guidance and follow up, and the short term effect of mitral valve replacement after mitral valve replacement is remarkable. But the long-term effect needs further study.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
本文编号：2403253
[Abstract]:Objective to analyze the causes, diagnosis and curative effect of aortic valve replacement after mitral valve replacement, and to discuss the experience and treatment of aortic valve replacement after mitral valve replacement, so as to provide reference for clinical diagnosis and treatment. Methods from January 1, 2008 to December 31, 2014, 55 patients who had undergone mechanical mitral valve replacement with recurrent aortic valve disease were retrospectively analyzed. Data of patients undergoing aortic valve replacement, There were 21 males and 34 females, aged (50.6 卤7.0) years, who were 15.4 卤5.4 years from the first cardiac surgery. The operation included aortic valve replacement (AVR) in 51 cases, double valve replacement in (DVR) (4 cases), aortic valve replacement (AVR) in 51 cases and double valve replacement (DVR) in 4 cases. Tricuspid valvuloplasty was performed in 10 cases and left atrial folding in 1 case at the same time. The valves are all double-lobed mechanical valves. Cardiac function was rated according to the New York Heart Association (NYHA) cardiac function criteria before and after treatment. All discharged patients were reviewed by outpatient and followed up by telephone. Results the main causes of aortic valve replacement after mitral valve replacement were the aggravation of aortic valve rheumatic disease (70.90%) and degenerative aortic valve disease (25.50%). Neoplasm formation in infective endocarditis (3.60%). Two cases died during hospitalization, the cause of death was multiple organ failure, the perioperative mortality was 3.64%. The monitoring time of ICU was 1 ~ 7 days (average 2.4 卤1.1 days), the hospitalization time was 10-44 days, and the average hospitalization days were 20.5 卤10.1 days. The postoperative complications occurred in 25 cases (45.5%). The average follow-up time was 30 months. There was no death during the follow-up period. The clinical symptoms of the patients were obviously relieved and the cardiac function recovered to a certain extent. There were 32 cases of II grade and 10 cases of III grade of cardiac function. The results of color echocardiography before and after operation showed that LVEDD and LA were significantly retracted at 1 week after operation (P0.05), but there was no significant difference in LVEF,LVFS, cardiac function grading before and after operation (P0.05). Three months after discharge, the degree of LVEDD,LA,LVEF,LVFS, cardiac function grade recovered significantly (P0.05). Conclusion 1. The main causes of aortic valve replacement after mitral valve replacement are aggravated rheumatic aortic valve disease, degenerative aortic valve disease, and neoplasm formation of infective endocarditis. Attention should be paid to the existence of high risk factors before operation, to the improvement of cardiac function before operation, to the selection of correct operative timing, to the protection of myocardium during the operation, to reasonable surgical methods and to appropriate perioperative treatment, After mitral valve replacement, aortic valve replacement can get good results. 3. After mitral valve replacement, we should do a good job of discharge guidance and follow up, and the short term effect of mitral valve replacement after mitral valve replacement is remarkable. But the long-term effect needs further study.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
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