摘要:
Objective Giant left ventricle indicates severe or irreversible pathologic injury of the cadiocytes in the left ventricle.This study was to investigate the effects of cardiac valve replacement on the volume of the left ventricle and systolic function of the heart.Methods We retrospectively analyzed the clinical data about 41 cases of cardiac valve replacement for giant left ventricle (left ventricle end diastolic dimension LVEDD ≥ 70 mm and left ventricle end systolic dimension LVESD ≥ 50 mm).We compared the LVEDD,LVESD and left ventricular ejection fraction (LVEF) of the patients before and at 1 week,3 months and 1 year after operation.Results Compared with the baseline,LVEDD and LVESD were decreased significantly at 1 week,3 months and 1 year after operation in a timedependent manner (P<0.01),while LVEF reduced at 1 week (P<0.01),restored to the preoperative level at 3 months (P=0.10),and increased at 1 year postoperatively (P<0.05).Based on the New York Heart Association (NYHA) functional classification,there were 16 cases of class Ⅱ,22 cases of class Ⅲ,1 case of class Ⅲ-Ⅳ,and 2 cases of class Ⅳ preoperatively.Follow-up was completed in 36 cases (87.8%),with a mean time of 50.03± 19.28 (12-95) months,during which 34 (94.4%) of the patients survived,including 24 cases of NYHA class Ⅰ and 10 cases of class Ⅱ,and 2 (5.6%) died,1 from chronic cardiac failure complicated by multiple organ failure and the other from liver cancer with systemic metastasis.Five (12.2%) of the cases were lost to follow up.Conclusion Cardiac valve replacement decreases the left ventricular volume of the patient with giant left ventricle in a time-dependent manner.The systolic function of the heart is reduced in the early postoperative period,which,however,may gradually improve with time and become better than the preoperative status.%目的 心脏巨大左心室的出现提示左心室心肌细胞已经出现严重的病理损坏.文章探讨瓣膜置换术对左心室容积及收缩功能的影响. 方法 回顾性分析2009年4月至2016年9月广东省心血管病研究所心外科收治的术前心脏B超左心室舒张末期内径(LVEDD)≥70 mm、左心室收缩末期内径(LVESD)≥50 mm的心脏瓣膜病合并巨大左心室41例患者资料.分别对患者术前、术后1周、术后3个月和术后1年的LVESD、LVEDD及左心室射血分数(LVEF)进行比较.结果 与治疗前相比,患者术后1周、3个月、1年LVEDD与LVESD逐渐下降并呈递减趋势,差异均有统计学意义(P<0.01);术后1周的LVEF较术前下降[(41.71±9.84)%vs(49.51±11.10),P<0.01],在术后3个月[(52.54±11.82)%]恢复至术前水平(P=0.10),术后1年[(56.59±10.89)%]升高(P<0.05).患者术前心功能分级(NYHA)Ⅱ级16例、Ⅲ级22例、Ⅲ~Ⅳ级1例、Ⅳ级2例.本组随访率为87.8%,随访12~95个月.2017年7月31月存活34例(94.4%),其中心功能Ⅰ级24例、心功能Ⅱ级10例.随访期间死亡2例,随访总死亡率为5.6%;失访5例,失访率为12.2%.1例患者死于慢性心功能不全合并多器官功能衰竭,1例患者死于肝癌伴全身转移. 结论 瓣膜置换术对巨大左心室患者左心室容积影响明显.随着术后时间的延长,患者左心室容积呈进行性缩小,心脏收缩功能在术后早期低于术前,但之后逐渐改善且较术前明显提高.