Cao Yukun, Gu Chunhu, Sun Guocheng, Yu Shiqiang, Wang Hongbing, Yi Dinghua
Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Heart Surg Forum. 2012 Jun;15(3):E145-9. doi: 10.1532/HSF98.20111124.
We performed the first quadruple valve replacement with mechanical valves, combined with the correction of complex congenital heart disease on November 17, 1999. We report here the 11-year follow-up study.
A 47-year-old man with subacute rheumatic endocarditis, a ventricular septal defect, and an obstruction of the right ventricular outflow tract required replacement of the aortic, mitral, tricuspid, and pulmonary valves; repair of the ventricular septal defect; and relief of the obstruction of the right ventricular outflow tract. The surgery was done on November 17, 1999, after careful systemic preparation of the patient. Warfarin therapy with a target international normalized ratio (INR) range of 1.5 to 2.0 was used. Follow-up included monitoring the INR, recording the incidences of thromboembolic and bleeding events, electrocardiography, radiography, and echocardiography evaluations.
The patient's INR was maintained between 1.5 and 2.0. All 4 mechanical prosthetic heart valves worked well. He is in generally good health without any thromboembolic or bleeding complications.
Long-term management is challenging for patients who have experienced quadruple valve replacement with mechanical valves; however, promising results could mean that replacement of all 4 heart valves in 1 operation is feasible in patients with quadruple valve disease, and an INR of 1.5 to 2.0 could be appropriate for Chinese patients with undergoing valve replacement with mechanical valves.
1999年11月17日，我们首次进行了机械瓣膜四瓣膜置换术，并同时矫治复杂先天性心脏病。在此报告11年的随访研究结果。
一名47岁男性，患有亚急性风湿性心内膜炎、室间隔缺损及右心室流出道梗阻，需要置换主动脉瓣、二尖瓣、三尖瓣和肺动脉瓣；修补室间隔缺损；解除右心室流出道梗阻。在对患者进行全面系统的准备后，于1999年11月17日实施手术。采用华法林治疗，目标国际标准化比值（INR）范围为1.5至2.0。随访包括监测INR、记录血栓栓塞和出血事件的发生率、心电图、影像学及超声心动图评估。
患者的INR维持在1.5至2.0之间。4个机械人工心脏瓣膜功能均良好。患者总体健康状况良好，无任何血栓栓塞或出血并发症。
对于接受机械瓣膜四瓣膜置换术的患者，长期管理具有挑战性；然而，良好结果表明，对于四瓣膜疾病患者，一次手术置换全部4个心脏瓣膜是可行的，且INR为1.5至2.0可能适合接受机械瓣膜置换术的中国患者。
