Magilligan D J, Lam C R, Lewis J W, Davila J C
Division of Thoracic & Cardiac Surgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, Michigan 48202, USA.
Circulation. 1978 Sep;58(3 Pt 2):I36-8.
Twenty-eight patients have undergone three operations on the mitral valve during 1958-1977. The first operation was closed mitral commissurotomy in 27 and open commissurotomy in one. After an average interval of 5.7 years, the 28 patients underwent a second operation. Operative procedures were: closed mitral commissurotomy in four, open commissurotomy in 14, and valve replacement in 10. After an average interval of 7.4 years, the third mitral valve operation was undertaken for congestive heart failure due to primary disease in 17 patients, prosthetic valve dysfunction in 10, and angina pectoris in one. At this time two patients were class II (New York Heart Association), 14 were class III, and 12 were class IV. Four died at 24 to 48 hours postoperatively, for a mortality rate of 14%. Analysis of risk factors revealed a significantly lower cardiac index (1.12 L/min/m2 +/- 0.35 SD) in those patients dying in the hospital compared to the cardiac index (2.73 L/min/m2 +/- 1.29 SD) of survivors. Deaths of patients undergoing a third operation on the mitral valve were related to poor ventricular function and not to previous surgery.
1958年至1977年间，28例患者接受了二尖瓣的三次手术。首次手术，27例行闭式二尖瓣交界切开术，1例行直视交界切开术。平均间隔5.7年后，这28例患者接受了第二次手术。手术方式为：4例行闭式二尖瓣交界切开术，14例行直视交界切开术，10例行瓣膜置换术。平均间隔7.4年后，因原发性疾病导致充血性心力衰竭，17例患者进行了第三次二尖瓣手术；因人工瓣膜功能障碍，10例患者进行了第三次二尖瓣手术；1例患者因心绞痛进行了第三次二尖瓣手术。此时，2例患者为纽约心脏协会心功能II级，14例为III级，12例为IV级。4例患者术后24至48小时死亡，死亡率为14%。危险因素分析显示，与存活患者的心指数（2.73L/分钟/平方米±1.29标准差）相比，住院死亡患者的心指数显著降低（1.12L/分钟/平方米±0.35标准差）。接受二尖瓣第三次手术患者的死亡与心室功能差有关，而非与既往手术有关。
