Tempe D K, Khanna S K, Banerjee A
Department of Anaesthesiology, GB Pant Hospital, New Delhi.
Indian Heart J. 1999 Sep-Oct;51(5):532-6.
Routine use of left ventricular vent is controversial in patients undergoing open heart surgery. However, surgeons use it during valvular surgery to maintain a dry field to make the operation easier. In addition it helps to prevent left ventricular distention during the critical period of rewarming and reperfusion, if ventricular function does not return immediately following the release of aortic cross clamp. In our country, patients present for valvular surgery at a very late stage and they often have severe left ventricular hypertrophy. This may affect the return of cardiac rhythm after the release of aortic cross clamp with progressive left ventricular distention. In the authors' experience, insertion of left ventricular vent through the apex is occasionally necessary to decompress the left ventricle as the left atrial vent usually fails to do so. This paper deals with retrospective analysis of the seven patients (out of a total of 395 patients who underwent valve surgery) who required insertion of left ventricular vent through the apex and reviews the beneficial effects of an apical left ventricular vent under refractory circumstances. It is recommended that insertion of left ventricular vent through apex should be strongly considered in patients having severe aortic valve disease with hypertrophied hearts, if cardiac rhythm in not restored with conventional management with left atrial vent and 3 to 5 DC shocks following the release of aortic cross clamp.
在接受心脏直视手术的患者中，常规使用左心室引流存在争议。然而，外科医生在瓣膜手术中使用它来保持手术视野干燥，使手术更易于操作。此外，如果在松开主动脉阻断钳后心室功能没有立即恢复，它有助于在复温和再灌注的关键时期防止左心室扩张。在我国，患者往往在瓣膜病非常晚期才来进行手术，并且常常伴有严重的左心室肥厚。这可能会随着左心室逐渐扩张而影响松开主动脉阻断钳后心律的恢复。根据作者的经验，由于左心房引流通常无法做到，偶尔需要通过心尖插入左心室引流来使左心室减压。本文对395例接受瓣膜手术的患者中7例需要通过心尖插入左心室引流的患者进行了回顾性分析，并探讨了在难治性情况下心尖左心室引流的有益效果。建议对于患有严重主动脉瓣疾病且心脏肥厚的患者，如果在松开主动脉阻断钳后采用左心房引流及3至5次直流电除颤的常规处理仍不能恢复心律，则应强烈考虑通过心尖插入左心室引流。
