CAJ | 학술논문

目的：总结小左心室(左心室舒张末期内径≤40mm)风湿性心脏病患者的外科治疗经验。方法对292例风湿性心脏病患者行体外循环心脏直视手术治疗，其中3例患者合并小左心室，本文对此3例患者的临床资料进行回顾性分析。结果1例于术后第6天死于多器官功能衰竭，其余2例痊愈出院，心功能恢复至I～I 级。随访13～18个月，心脏彩超显示左心室舒张末期内径分别为45 mm和46 mm，左心室射血分数分别为0.78和0.76，均较术前改善(P＜0.05)。结论小左心室患者病程长，病情重，多合并三尖瓣关闭不全及肺动脉高压，晚期部分患者可发展为左心室萎缩及右心功能不全，手术风险大，死亡率高；重视围手术期处理，可以提高手术疗效。
목적：총결소좌심실(좌심실서장말기내경≤40mm)풍습성심장병환자적외과치료경험。방법대292례풍습성심장병환자행체외순배심장직시수술치료，기중3례환자합병소좌심실，본문대차3례환자적림상자료진행회고성분석。결과1례우술후제6천사우다기관공능쇠갈，기여2례전유출원，심공능회복지I～I 급。수방13～18개월，심장채초현시좌심실서장말기내경분별위45 mm화46 mm，좌심실사혈분수분별위0.78화0.76，균교술전개선(P＜0.05)。결론소좌심실환자병정장，병정중，다합병삼첨판관폐불전급폐동맥고압，만기부분환자가발전위좌심실위축급우심공능불전，수술풍험대，사망솔고；중시위수술기처리，가이제고수술료효。
Objective To summarize the surgical treatment experience of severe rheumatic mitral stenosis patient with small left ventricle (left ventricular end diastolic diameter≤ 40mm).Methods 292 cases of rheumatic heart disease patient including 3 cases of severe mitral stenosis patient with small left ventricle received open heart surgery by cardiopulmonary bypass. The clinical data of 3 cases of severe mitral stenosis patient with small left ventricle was analyzed retrospectively.Results 1 case died of multiple organ failure secondary to hypoxemia, pulmonary infection, low cardiac output syndrome and acute renal failure. The other 2 cases were cured and discharged, and their cardiac function recovered to grade I to II. During the following-up period with 13 to 18 months, left ventricular end diastolic diameter of 2 cases was respective 45mm and 46mm, and left ventricular ejection fraction was respective 0.78 and 0.76. The two indexes were improved compared with preoperative indexes.Conclusion Severe rheumatic mitral stenosis patient with small left ventricle usually associates with long duration, serious condition, tricuspid valve insufficiency and pulmonary arterial hypertension, even a part of patient develops into left ventricular atrophy and right heart insufficiency in advanced stage. So severe rheumatic mitral stenosis patient with small left ventricle has greater operation risk and higher mortality. If more attention was paid to perioperative treatment for severe rheumatic mitral stenosis patient with small left ventricle, the effect of operation could be improved.