Pelletier C, Bizri F S, Cossette R, Dontigny L, Levy R
Can J Surg. 1977 Mar;20(2):101-6.
In 343 patients treated surgically for mitral valve disease, there was thrombosis of the left atrium in 40. Massive atrial thrombosis was present in 32 of them, yet the diagnosis was suspected or established preoperatively in only 12, because of insufficient clinical signs. A transventricular mitral commissurotomy was performed in 32 patients and mitral valve replacement in the remaining 8. Surgical mortality was 23% in the patients with atrial thrombosis compared with 7% in the trombus-free patients: 66% of the deaths were due to cerebral embolism. Systemic embolism occurred in 17% of the patients who had a closed approach initially and in 27% following a planned open procedure. Among the survivors, 65% were asymptomatic or markedly improved; the average follow-up was 42 months. Atrial thrombosis increases the surgical risk because of the high incidence of operative embolism, a complication that is not avoided by the use of open procedures, but that could be prevented by earlier surgical treatment of mitral stenosis, before atrial thrombi develop.
在343例接受二尖瓣疾病手术治疗的患者中，40例出现左心房血栓形成。其中32例存在大量心房血栓，但由于临床体征不足，术前仅12例被怀疑或确诊。32例患者行经心室二尖瓣交界切开术，其余8例行二尖瓣置换术。心房血栓形成患者的手术死亡率为23%，无血栓患者为7%：66%的死亡归因于脑栓塞。最初采用闭式手术的患者中17%发生全身栓塞，计划行开放手术的患者中27%发生全身栓塞。在幸存者中，65%无症状或明显改善；平均随访42个月。心房血栓形成增加了手术风险，因为手术栓塞发生率高，这种并发症不能通过开放手术避免，但可通过在心房血栓形成之前对二尖瓣狭窄进行早期手术治疗来预防。
