Mesa J M, Oliver J, Cortina J M, Domínguez F, Moreno I, Larrea J L, Calvo L, Maté I, Sobrino J A
Unidad Médico-Quirúrgica de Cardiología, Hospital La Paz, Universidad Autónoma de Madrid.
Rev Esp Cardiol. 1990 Aug-Sep;43(7):466-70.
From 1975 to 1988 we have operated 117 patients with left arterial thrombosis associated with rheumatic mitral valve disease. Seventy-seven were female and 40 male, with ages ranging from 22 to 69 years. In 75 cases (64.1%) the valvular lesion was mitral stenosis. Embolic antecedents were present in 38 cases (32.4%) and 95 patients (81.1%) were in class III or IV of the NYHA functional classification. In 48 cases we performed a mitral commissurotomy and in 51 cases mitral valve replacement, associated to left artrial thrombectomy. In the remaining 18 patients we made other valve procedures. The hospital mortality was 15 cases (12.8%), eight because low cardiac output, four because severe brain injury and three because posterior atrioventricular sulcus disruption. In 41.1% of the survivors there was serious hospital complications, standing out the incidence of 8 cases of transient neurologic accidents. We have followed 98 of the 102 hospital survivors between 10 and 140 months (mean 57 months). Three patients died in the follow-up, two of them during a reintervention because bioprosthesis disfunction and the third one during a reintervention because prosthetic infective endocarditis. Nine additional patients were reoperated because recidivant valvular lesions or because prosthetic disfunction, and two patients suffered embolic events during the follow-up. The antithrombotic therapy was abandoned in 19.6% of patients. At present 73.6% are in functional class I and 26.3% in class II. The association of left atrial thrombosis with with mitral valve disease induce a surgical morbimortality greater than usual for isolated valvular lesions, being mandatory a watchfull surgical technic.(ABSTRACT TRUNCATED AT 250 WORDS)
1975年至1988年期间，我们为117例患有与风湿性二尖瓣疾病相关的左心房血栓形成的患者实施了手术。其中女性77例，男性40例，年龄在22岁至69岁之间。75例（64.1%）患者的瓣膜病变为二尖瓣狭窄。38例（32.4%）有栓塞病史，95例（81.1%）患者属于纽约心脏协会（NYHA）心功能分级的III级或IV级。48例患者接受了二尖瓣交界切开术，51例患者接受了二尖瓣置换术，并同时进行了左心房血栓切除术。其余18例患者接受了其他瓣膜手术。医院死亡率为15例（12.8%），8例死于低心排血量，4例死于严重脑损伤，3例死于后房室沟破裂。41.1%的幸存者出现了严重的医院并发症，其中8例短暂性神经系统意外的发生率较为突出。我们对102例医院幸存者中的98例进行了10至140个月（平均57个月）的随访。3例患者在随访期间死亡，其中2例在再次干预时因生物瓣膜功能障碍死亡，第3例在再次干预时因人工瓣膜感染性心内膜炎死亡。另外9例患者因瓣膜病变复发或人工瓣膜功能障碍接受了再次手术，2例患者在随访期间发生了栓塞事件。19.6%的患者放弃了抗血栓治疗。目前，73.6%的患者心功能为I级，26.3%为II级。左心房血栓形成与二尖瓣疾病的关联导致手术病死率高于单纯瓣膜病变，因此必须采用谨慎的手术技术。（摘要截断于250字）
