风心病二尖瓣狭窄合并小左心室的瓣膜替换术.pdf

1997 2 13 1 ·1 · ·· 徐志云　张宝仁　朱家麟　郝家骅 　　　1987～ 1993 389 (MS)(MVR)126 , 28 。III 76 、IV 35 , 64 。 9.5%, 。、。 1.6%/-, 1、5 96.5%88.4%。 , 。, , MS , , 。 　　　　　 V al ve Replacement in Rheumatic M itral Stenosis with Small Left V entricl e X u Z hiy u n, Zhang Baoren, Zh u J iali n, et al . I nst it ute of Card iac and Thoracic Surgery Changhai Hosp i tal, second M il it ary Uni versi ty , S hanghai 200433 Abstract This paper evaluates the risk factors a d lo g-term prog osis of surgical treatme t o patie ts w ith rheumatic mitral ste osis a d small left ve tricle.From 1987 through 1993, 389 patie ts with rheumatic mitral ste osis(MS)u derw e t mitral valve replaceme t(MVR).A small left ve tricle(LV)was prese t i 126 cases, a d w as associated with LV atrophy i 28.Seve ty-six cases w ere i heart fu ctio al class III a d 35 i class IV.Sixty-four cases had severe pulmo ary hyperte - sio .The i cide ce of postoperative low cardiac output w as 22.2%.Operative mortality rate was 9.5%, obviously higher tha that of patie ts w ithout small LV.The causes of death mai ly were right heart failure, acute left heart failure a d pros- thetic valve malfu ctio .Late mortality rate w as 1.6%per patie t-year.The survival rate at 1 a d 5 years w as respectively 96.5%a d 88.4%.Serial postoperative echocardiography show ed prog ressive structural reco structio a d fu ctio al recov- ery of the small LV or small LV w ith atrophy.But, the fu ctio al recovery took a relatively lo ger time.T he results show that small LV or small LV with atrophy mai ly i flue ce the early outcome of operatio .Severe MS w ith small LV, especially w ith severe pulmo ary hyperte sio a d LV atrophy,m ay be co sidered a high risk factor fot MVR. Key word s Mitral ste