【摘要】 目的 :探讨瓣膜替换术瓣膜的选择 ,瓣周漏的发生机理 ,保留瓣下结构的二尖瓣替换术 (MVRP)对心功能的保护效果及术后可否妊娠。方法 :对 1976年 1月～ 1996年 1月 ,中山医科大学附一医院心胸外科施行瓣膜替换术10 5 1例 12 6 7个瓣的回顾性分析。结果 :随访 5～ 11年 ,机械瓣生存率 91% ,生物瓣为 75 % ,瓣周漏的发生与缝合方法无关。MVRP对重症二尖瓣替换术死亡率为 9.7% ,较以往的 2 4 .1%有所减少 ,术后心功能在Ⅰ～Ⅱ级其妊娠分娩死亡率为 0。结论 :(1)选择瓣膜时 ,以机械瓣为主 ,国产瓣与进口瓣视经济情况而定 ;(2 )瓣周漏的发生与缝合方式无明显的相关性 ,而是决定于瓣膜的病理改变 ;(3)MVRP有助于心功能的改善 ,但必须严格掌握其适应症 ;(4)瓣膜置换术后 ,能否妊娠决定于心功能的改善更多还原

【Abstract】 Objective:To investigate the choice of replacement device, the risk factors of periprosthetic leakage, the preservation of left ventricular function after mitral valve replacement with preservation of papillary muscles and chordae tendinae(MVRP), and the decided factors of whether those patients can be pregnant after valve replacement. Methods: 1051 Cases of valve replacement operated on in The First Affiliated Hospital of Sun Yat-sen University of Medical Science from 1976～1996 were analyzed. Results: Within the follow-up period of 5 to 11 years, late survival of mechanical was 91% and the bioprothesis was 75%.The incidence of periprosthetic leakage was not related to the suture techniques.MVRP decreased the hospital mortality of the imminent patients to 9.7%, compared with previous 24.1%.The mortality of patients after valve replacement was zero during pregnace in the group of NYNA classⅠ～Ⅱ.Conclusion: (1) The mechanical prosthesis rather than the bioprothesis is commonly recommended.(2)The incidence of periprosthetic leakage is not related to the suture techniques but is mainly to the morphology of the valve. (3) MVRP would decrease the depression of the left ventricular function but its indication must be mastered strictly. (4) Whether those patients after valve replacement can be pregnant depends on ventricular function.更多还原