疑难病杂志2011，Vol.10Issue(8)：580-582,3.DOI:10.3969/j.issn.1671-6450.2011.08.008
合并重度肺动脉高压瓣膜病患者行机械瓣膜置换的围术期治疗
Perioperative management of mechanical valve replacement in patients with valvular heart diseases complicated by severe pulmonary artery hypertension
刘湘君 1景小勇 1李洪银 1潘广玉 1吴清玉1
作者信息
- 1. 100016,北京,清华大学第一附属医院心脏中心
- 折叠
摘要
Abstract
Objective To summarize the perioperative management of mechanical valve replacement in patients with valvular heart diseases complicated by severe pulmonary artery hypertension. Methods The clinical data of 41 patients with valvular heart diseases complicated by severe pulmonary artery hypertension( PASP ＞ 70mmHg ) performed mechanical valve replacement recently in the hospital were analyzed. Among 21 of them were cases with MVR ( mitral valve replacement, 19 cases of rheaumatic diseases, 2 cases of prolapse ), 4 cases with AVR ( aortic valve replacement, 3 cases of rheumatic diseases,1 case of bicuspid aortic valve ) and 16 cases with MVR + AVR ( all rheumatic heart diseases ). 27 cases with De Vega TVP ( tricuspid valvuloplasty ), 3 cases with coronary artery bypass grafting, and 6 cases with left atrial thrombectomy were performed concomitantly. Echocardiography was employed to evaluate the operation effect and preoperative, intraoperative and postoperative care were reviewed. Results Two of 41 cases were death ( 4.9％ ), 2 cases of renal failure ( 4.9％ ) in perio perative stage. The average pulmonary artery pressure dropped significantly 1 week after surgery( 91 mmHg ± 19 mmHg vs 37 mmHg ± 10 mmHg ), then dropped to ( 35 ± 13 )mmHg at 3 months later. All of the patients recovered to NYHA function class Ⅰ ～ Ⅱ at 3 months later. Conclusion Valve replacement significantly decreased the pulmonary artery pressure of valve diseases and improved cardiac function of valvulopathy patients. On the precondition of complete pre-operation preparation, appropriate operation scheme, prevention and treatment of post-operation complication, severe pulmonary artery hypertension did not increase the mortality rate of mechanical valve replacement.关键词
肺动脉高压/心脏瓣膜病/瓣膜置换术,机械瓣/围术期治疗Key words
Pulmonary artery hypertension/ Valvular heart disease/ Valve replacement/ Mechanical valve/ Perioperative period management引用本文复制引用
刘湘君,景小勇,李洪银,潘广玉,吴清玉..合并重度肺动脉高压瓣膜病患者行机械瓣膜置换的围术期治疗[J].疑难病杂志,2011,10(8):580-582,3.
