冠状动脉搭桥同期行瓣膜置换术近期疗效

首都医科大学学报 ›› 2006, Vol. 27 ›› Issue (4): 531-533.

冠状动脉搭桥同期行瓣膜置换术近期疗效

徐东, 张建, 刘燕晖, 尚学斌, 李学峰, 王寿余, 刘飞, 李洪利

首都医科大学宣武医院心血管外科

收稿日期:2005-03-11 修回日期:1900-01-01 出版日期:2006-08-24 发布日期:2006-08-24

Short Term Follow-up for Coronary Artery Bypass Grafting Combined with Valve Replacement Surgery

Xu Dong, Zhangjian, Liu Yanhui, Shang Xuebin, Li Xuefeng, Wang Shouyu, Liu Fei, Li Hongli

Department of Cardiovascular Surgery, Xuanwu Hospital, Capital University of Medical Sciences

Received:2005-03-11 Revised:1900-01-01 Online:2006-08-24 Published:2006-08-24

摘要/Abstract

摘要： 目的探讨冠状动脉粥样硬化性心脏病(冠心病)合并心脏瓣膜病,风湿性心脏病合并冠心病同期行冠状动脉搭桥术(CABG)及瓣膜置换术的安全性及适应证.方法首都医科大学宣武医院心血管外科自2001年5月至2004年12月间,在中低温体外循环下完成12例冠心病合并瓣膜病变、风湿性心脏病合并冠心病同期施行冠状动脉搭桥和瓣膜替换手术.12例中男8例,女4例,年龄52～78岁,平均64.5岁.3例以多年风湿性心脏病、心功能不全为主诉,近年出现胸痛,手术前冠状动脉造影发现冠状动脉病变;9例以心肌缺血症状为主诉,同时合并瓣膜病变.冠状动脉造影提示单支病变1例,双支病变3例,3支病变8例.合并原发性高血压8例,糖尿病6例,心力衰竭病史5例,心房颤动7例.手术前左心室舒张末期内径(LVED)45～87 mm [(56.7±77) mm],左心室射血分数(LVEF)24%～67%(50.3%±11.7%).心功能NYHAⅠ级1例,Ⅱ、Ⅲ和Ⅳ级分别为8、2和1例.12例患者中MVR(二尖瓣置换)+CABG 9例,AVR(主动脉瓣置换)+CABG 2例,DVR(双瓣置换)+CABG 1例.结果全组术后恢复顺利,随访3个月至2年无1例死亡.结论年龄超过50岁风湿性心脏病患者,无论有无心绞痛症状均需行冠状动脉造影检查,决定是否同期行CABG;冠心病合并二尖瓣中到重度反流及主动脉瓣严重钙化者,应同期行瓣膜置换术.对于冠状动脉病变与瓣膜病变同时存在的病例,2种手术同期进行可降低病死率,改善预后.

关键词: 冠状动脉粥样硬化性心脏病, 风湿性心脏病, 冠状动脉搭桥术, 瓣膜替换术

Abstract: ObjectiveTo study the indications and safety in the surgery of CABG combined with valvular replacement for the patients with both CHD and rheumatic heart diseases(RHD) or valvular diseases.Methods In 12 cases of patients with combined coronary artery and valvular heart diseases CABG and valvular replacement surgery were performed from 2001 May to 2004 December in Xuanwu Hospital,CUMS.Moderate hypothermia myocardial protection was used in cardiopulmonary bypass.8 cases of 12 are males,4 cases are females,age ranging 52 to 78(mean 64.5).3 cases presented with RHD,preoperative angiography indicated coronary artery disease.9 cases presented with coronary artery disease(CAD) combined with valve disease.Angiography of 12 cases showed single vessel disease in 1 case,double vessel disease in 3 cases,and three vessel disease in 8 cases,associated with hypertension in 8,diabetes in 6,heart disfunction in 5,and atrial fibrillation in 7.Left ventriclar end diastolic diameter showed 45～87 mm [mean(56.7±77) mm],left ventriclar ejection fraction demonstrated 24%～67%(mean 50.3%±11.7%).Heart function(NYHA) showed grade Ⅰ in 1 cases,Ⅱ,Ⅲ,Ⅳ in 8,2,1 cases respectively.9 out of 12 underwent CABG+MVR(mitral valve replacement),CABG+AVR(aortic valve replacement) in 2,DVR(double valve replacement) in 1.Results All cases in this study recovered smoothly both peroperatively and postoperatively,no death was found after 3 months to 2 years follow up.Conclusion Coronary angiography is indicated for the patients presented with RHD aging above 50 regardless of the manifestation of pectoris angina or not.Valvar replacement is performed for the patients suffered from CAD combined moderate to severe MI or severe aortic valve calcification.For the cases with combined CAD and valve diseases,CABG plus valve replacement might result in the difficulty of procedures,however it might be beneficial for patients in terms of the prognosis and decreasing mortality in particular.

Key words: coronary artery disease, rheumatic heart disease, coronary artery bypass grafting, valve replacement

中图分类号:

R654.2

徐东;张建;刘燕晖;尚学斌;李学峰;王寿余;刘飞;李洪利. 冠状动脉搭桥同期行瓣膜置换术近期疗效[J]. 首都医科大学学报, 2006, 27(4): 531-533.

Xu Dong;Zhangjian;Liu Yanhui;Shang Xuebin;Li Xuefeng;Wang Shouyu;Liu Fei;Li Hongli. Short Term Follow-up for Coronary Artery Bypass Grafting Combined with Valve Replacement Surgery[J]. Journal of Capital Medical University, 2006, 27(4): 531-533.

[1]	陈璐, 郭新颖, 刘建, 杜凤和, 郭彩霞. 冠状动脉粥样硬化性心脏病患者可溶性高级糖基化终末产物受体与肾功能的相关性分析[J]. 首都医科大学学报, 2022, 43(2): 167-172.
[2]	夏宁, 聂秀红, 王昊, 樊晓君. 支气管哮喘合并OSA与冠心病发病率的相关性研究[J]. 首都医科大学学报, 2022, 43(1): 138-142.
[3]	刘瑾春, 郑秀花, 李宁, 张瑞霞, 张海柱. 不稳定型心绞痛患者冠状动脉侧支循环形成的预测因素研究[J]. 首都医科大学学报, 2021, 42(4): 642-646.
[4]	谷珊珊, 卢洁, 陈刚. 心肌灌注显像半定量分析对不同缺血程度老年冠状动脉粥样硬化性心脏病的诊断价值[J]. 首都医科大学学报, 2021, 42(1): 26-30.
[5]	胡宾, 周玉杰, 贾德安, 秦政, 许晓晗, 杨士伟, 周志明. 冠状动脉斑块旋磨联合药物洗脱支架术对不同年龄段老年钙化治疗效果的对比分析[J]. 首都医科大学学报, 2021, 42(1): 101-104.
[6]	李响, 蒲连美, 阮杨, 李红, 金泽宁. 汉族人群ADIPOR1 rs7539542与冠状动脉粥样硬化性心脏病和2型糖尿病的关联分析[J]. 首都医科大学学报, 2020, 41(6): 935-942.
[7]	许晓晗, 程宇婧, 刘晓丽, 周玉杰. 守护生命的“心”路——周玉杰教授[J]. 首都医科大学学报, 2020, 41(5): 844-848.
[8]	李扬, 董然, 芮宏亮, 刘韬帅, 郑居兵, 徐晓宇, 赵洋, 宋邦荣, 张魁. 合并慢性肾功能不全的冠状动脉粥样硬化性心脏病患者冠状动脉搭桥手术的预后及其影响因素[J]. 首都医科大学学报, 2020, 41(4): 597-602.
[9]	魏嘉洁, 矫杰, 周迎生. 2型糖尿病合并阻塞性睡眠呼吸暂停综合征的临床特征及其危险因素[J]. 首都医科大学学报, 2020, 41(1): 35-39.
[10]	熊筱伟, 郭彩霞, 徐晓薇, 穆利英, 胡宏宇, 陈威, 陈步星. 血浆氧化三甲胺及其前体物质浓度与冠状动脉粥样硬化性心脏病的关系[J]. 首都医科大学学报, 2020, 41(1): 99-102.
[11]	夏勇, 张建卿, 王少霞, 陈丹, 姬建民. 沙库巴曲缬沙坦联合琥珀酸美托洛尔缓释片治疗冠状动脉粥样硬化性心脏病并慢性心力衰竭的效果观察[J]. 首都医科大学学报, 2020, 41(1): 113-118.
[12]	李靖, 高敬. 二尖瓣环自动追踪技术评价冠状动脉粥样硬化性心脏病病人左心室收缩功能[J]. 首都医科大学学报, 2017, 38(3): 386-390.
[13]	王德昭, 马宁, 胡宏宇, 莫大鹏, 付强, 陈威, 姜桂莹, 缪中荣, 陈步星. 冠状动脉病变与弓上动脉颅内外段病变相关性探讨[J]. 首都医科大学学报, 2016, 37(1): 58-61.
[14]	杨耀国, 陈忠, 唐小斌, 寇镭, 吴章敏, 刘晖, 王盛, 张征, 贾云峰, 何楠. 腹主动脉瘤合并冠心病的临床特点及围术期处理[J]. 首都医科大学学报, 2015, 36(1): 23-27.
[15]	陈文明, 李东宝, 陈晖, 李虹伟, 赵捷, 赵慧强, 梁思文, 丁晓松. 冠状动脉病变支架后非罪犯病变快速进展的预测因子[J]. 首都医科大学学报, 2013, 34(1): 90-94.