Zhang B R, Zhu J L, Hao J H
Changhai Hospital, Second Military Medical University, Shanghai.
Zhonghua Wai Ke Za Zhi. 1994 Jun;32(6):325-8.
Between 1982 and May 1993, we operated on 680 patients with combined valvular disease. Previous operations were including closed mitral commissurotomy in 87, and bioprosthetic valve replacement in mitral position in 15. The types of combined valve disease included mitral valve disease combined with functional tricuspid regurgitation (FTR) (245), with organic tricuspid disease (OTD) (10); mitral and aortic disease (258), combined with FTR (128), and with OTD (39). The early mortality was 4.7% in total 2.4% and 6.1% respectively in MVR or DVR plus tricuspid procedures. The main cause of early death was low cardiac output syndrome. The late mortality was 2.6% pt-yr, congestive heart failure and coagulant-related hemorrhage were the predominant causes of late death. We considered that FTR is the outcome of right ventricle decompensation, while tricuspid valve must be actively inspected intraoperatively, and must be corrected completely. OTD can be successfully repaired in most patients. Myocardial protection should be emphasized, and continuous perfusion of cold blood cardioplegia and controlled reperfusion of warm blood contained mannitol have marked effect.
1982年至1993年5月期间，我们对680例联合瓣膜病患者进行了手术。既往手术包括87例闭式二尖瓣交界切开术以及15例二尖瓣位生物瓣置换术。联合瓣膜病的类型包括二尖瓣病变合并功能性三尖瓣反流（FTR）（245例）、合并器质性三尖瓣病变（OTD）（10例）；二尖瓣和主动脉瓣病变（258例），合并FTR（128例）以及合并OTD（39例）。总早期死亡率为4.7%，二尖瓣置换术（MVR）或主动脉瓣置换术（DVR）加三尖瓣手术的早期死亡率分别为2.4%和6.1%。早期死亡的主要原因是低心排血量综合征。晚期死亡率为每年2.6%，充血性心力衰竭和凝血相关出血是晚期死亡的主要原因。我们认为FTR是右心室失代偿的结果，术中必须积极检查三尖瓣，并进行彻底纠正。大多数患者的OTD能够成功修复。应强调心肌保护，持续冷血心脏停搏液灌注以及含甘露醇的温血控制性再灌注效果显著。
