【摘要】 目的　分析和评价风湿性心脏病二尖瓣、主动脉瓣、三尖瓣联合瓣膜病手术治疗的效果。方法　手术治疗三瓣膜联合病变 2 0例 ,其中二次瓣膜手术 2例 ,感染性心内膜炎 4例 ,肺动脉高压 7例。心功能Ⅳ级 1 6例 ,Ⅲ级 4例。 2 0例病人均行二尖瓣和主动脉瓣双瓣置换术 ,1 8例病人行三尖瓣成形术。结果　心脏自动复跳占 75 %。手术死亡 1例 ,病死率 5 %。并发症 3例 ,发生率1 5 %。结论　强调完善的围手术期处理和精细的手术操作 ,并建议在行DeVega三尖瓣成形术时 ,待心脏复跳后调节瓣环大小再打结。对于肺动脉高压者 ,行肺动脉直接置管 ,测压、给药。更多还原

【Abstract】 Objective To evaluate the clinical results of surgical treatment of combined mitral,aortic,tricuspid valve disease with rheumatic etiology.Methods Twenty patients with combined triple valve disease were treated surgically.Two cases were redo valve procedure,four patients had concomitant endocarditis,and seven had combined pulmonary hypertension.Heart function was class Ⅳ in 16 and class Ⅲ in four patients.Mitral and aortic valve replacements were performed in all patients.Modified DeVega annuloplasty was carried out on 18 patients.Results The spontaneous heart beats occurred in 75% of the patients after aortic declamping.There was only one operative death with a mortality of 5% and three early postoperative complications with a mobility of 15%.Conclusion The proper perioperative management and careful surgical techniques were emphasized.We suggest DeVega annuloplasty be performed after heart beat occurrence and pulmonary artery catheterization be carried out for pulmonary hypertension.更多还原