Sheares J H, Tan K T, Wu D C, Chia F K, Tan N C
Ann Acad Med Singap. 1981 Oct;10(4 Suppl):101-9.
Over the last three decades there has been a world-wide decline in the incidence and severity of rheumatic fever and rheumatic heart disease, but the death rate in Singapore from chronic rheumatic heart disease has risen from 3.6 per 100,000 population in 1966 to 4.4 per 100,000 in 1977. Valvular lesions from rheumatic heart disease are very common, and between 1967 to 1979, 715 surgical procedures were performed for rheumatic valvular disease, and of these, 654 procedures involved the mitral valve which was most commonly affected by the disease process. Since many of the patients were female and in the child-bearing age, conservative procedures on the mitral valve were performed whenever possible. Mitral valvotomy for mitral stenosis relieved symptoms effectively; and for restenosis of the mitral valve, more than half of the patients underwent a second valvotomy with functional improvement. Mitral valve replacement was reserved for the severely distorted valve, sometimes calcified, and where there was stenosis associated with incompetence. Between 1971 to 1979, 162 mitral valves were replaced and actuarial studies showed 80% survival five years after surgery. 30 aortic and mitral valve replacements were performed in this same period with an operative mortality of 16.7%. Only 75 aortic valves were replaced for rheumatic valvular disease and 14 of these also had associated mitral and triscuspid valve disease. The prosthetic valves commonly used for replacement were the Starr-Edwards non-cloth covered valves, models 6120 and 1260. All patients that had valve replacements were treated with long-term anticoagulation with Warfarin. The incidence of thromboembolism was low, being 8% for mitral valve replacement and the majority of these episodes occurred in the first three months after surgery.
在过去三十年中，风湿热和风湿性心脏病的发病率及严重程度在全球范围内呈下降趋势，但新加坡慢性风湿性心脏病的死亡率却从1966年的每10万人口3.6例升至1977年的每10万人口4.4例。风湿性心脏病导致的瓣膜病变非常常见，在1967年至1979年期间，共进行了715例风湿性瓣膜病手术，其中654例涉及二尖瓣，二尖瓣是受疾病影响最常见的瓣膜。由于许多患者为育龄女性，因此尽可能采用二尖瓣保守手术。二尖瓣狭窄的二尖瓣切开术能有效缓解症状；二尖瓣再狭窄的患者中，超过一半接受了二次二尖瓣切开术，症状得到改善。二尖瓣置换术仅用于瓣膜严重变形、有时伴有钙化且存在狭窄合并关闭不全的情况。1971年至1979年期间，共置换二尖瓣162例， actuarial研究显示术后五年生存率为80%。同期进行了30例主动脉瓣和二尖瓣置换术，手术死亡率为16.7%。仅75例因风湿性瓣膜病置换主动脉瓣，其中14例还伴有二尖瓣和三尖瓣疾病。常用的置换人工瓣膜是Starr-Edwards无布覆盖瓣膜，型号为6120和1260。所有接受瓣膜置换的患者均接受华法林长期抗凝治疗。血栓栓塞的发生率较低，二尖瓣置换术后为8%，且大多数此类事件发生在术后头三个月。
