Hamer J, Boulton T, Fleming J, Hayward G W, Hill I M, Monro I, Simon G, Tubbs C S
Thorax. 1968 Jan;23(1):1-10. doi: 10.1136/thx.23.1.1.
The first 16 patients to have mitral valve replacement with the Starr-Edwards prosthesis at St. Bartholomew's Hospital, London, were reviewed from one to three years after operation. These patients had presented with serious mitral valve disease and there was a high incidence of severe dyspnoea and persistent congestive failure before operation. There were four operative deaths, and two survivors had poor results due to regurgitation alongside the prosthesis. The remaining 10 patients showed considerable improvement. Although no diuretics were given after operation there was little dyspnoea and congestive failure resolved. Anticoagulant therapy is given after operation, and there have been few embolic incidents. The pulmonary vascular resistance was raised to between 6 and 11 units before operation in six patients. There was no undue mortality in this group, and post-operative cardiac catheterization showed a considerable fall in resistance and an increase in cardiac output, suggesting resolution of the pulmonary vascular obstruction. Tricuspid incompetence in these patients disappeared post-operatively. We conclude that mitral valve replacement can restore a patient severely disabled by mitral valve disease to a nearly normal life. We do not regard pulmonary hypertension as a contraindication to operation.
对伦敦圣巴塞洛缪医院首批16例使用斯塔尔-爱德华兹人工瓣膜进行二尖瓣置换术的患者进行了术后1至3年的随访。这些患者均患有严重的二尖瓣疾病，术前重度呼吸困难和持续性充血性心力衰竭的发生率很高。手术死亡4例，2例幸存者因人工瓣膜旁反流效果不佳。其余10例患者有明显改善。术后未使用利尿剂，呼吸困难轻微，充血性心力衰竭得到缓解。术后给予抗凝治疗，栓塞事件很少。6例患者术前肺血管阻力升至6至11单位。该组患者无过高死亡率，术后心导管检查显示阻力显著下降，心输出量增加，提示肺血管阻塞得到缓解。这些患者的三尖瓣关闭不全术后消失。我们得出结论，二尖瓣置换术可使因二尖瓣疾病严重致残的患者恢复到接近正常的生活。我们不认为肺动脉高压是手术的禁忌症。
