Objective To summarize the perioperative management of mechanical valve replacement in patients with valvular heart diseases complicated by severe pulmonary artery hypertension.Methods The clinical data of 41 patients with valvular heart diseases complicated by severe pulmonary artery hypertension(PASP >70mmHg) performed mechanical valve replacement recently in the hospital were analyzed.Among 21 of them were cases with MVR(mitral valve replacement,19 cases of rheaumatic diseases,2 cases of prolapse).,4 cases with AVR(aortic valve replacement,3 cases of rheumatic diseases, 1 case of bicuspid aortic valve) and 16 cases with MVR + AVR(all rheumatic heart diseases).27 cases with De Vega TVP (tricuspid valvuloplasty),3 cases with coronary artery bypass grafting,and 6 cases with left atrial thrombectomy were performed concomitantly.Echocardiography was employed to evaluate the operation effect and preoperative,intraoperative and postoperative care were reviewed.Results Two of 41 cases were death(4.9%),2 cases of renal failure(4.9%) in perio perative stage.The average pulmonary artery pressure dropped significantly 1 week after surgery(91 mmHg + 19 mmHg vs 37 mmHg±10 mmHg),then dropped to(35±13) mmHg at 3 months later.All of the patients recovered to NYHA function classⅠ～Ⅱat 3 months later.Conclusion Valve replacement significantly decreased the pulmonary artery pressure of valve diseases and improved cardiac function of valvulopathy patients.On the precondition of complete pre-operation preparation,appropriate operation scheme,prevention and treatment of post-operation complication,severe pulmonary artery hypertension did not increase the mortality rate of mechanical valve replacement.

目的 总结分析瓣膜病合并重度肺动脉高压患者行机械瓣膜置换术的围术期治疗经验.方法 分析瓣膜病合并重度肺动脉高压(肺动脉收缩压>70 mmHg)的机械瓣膜置换术患者41例,其中二尖瓣置换术(MVR)21例(风心病19例,脱垂2例),主动脉瓣置换术(AVR)4例(风心病3例,二叶瓣畸形1例),双瓣置换术(MVR+AVR)16例(均为风心病),同时行De Vega三尖瓣成形术27例,冠状动脉旁路移植术3例,左房血栓清除术6例.回顾术前治疗措施、术中注意事项、术后治疗方法,通过超声心动图评价恢复情况.结果 41例患者中死亡2例(4.9%),围术期发生肾功能不全2例(4.9%).术后随访12～66个月,心功能均恢复至I～II级.肺动脉压力术后1周显著下降(91 mmHg±19 mmHg vs 37 mmHg±10 mmHg),3个月后进一步下降至(35±13)mmHg.结论 瓣膜置换术可显著降低瓣膜病患者的肺动脉压力,进而改善其心功能.在术前准备周密、手术方案合理、积极预防和处理好术后并发症的前提下,重度肺动脉高压并不显著增加机械瓣膜置换手术的病死率.

Objective To construct a rabbit model of vein graft simulating the pathology of human saphenous vein graft.Methods The studies were performed on New Zealand white rabbits(8 cases),weighing 3.0 ～ 3.5 kg.Every rabbit’s unilateral jugular vein was anastomosed with common carotid artery end to end with interrupted suture.Results After 2 weeks and 4 weeks,samples of tissues were harvested and examined under a light microscope.The neointimal and medial layers showed significant hyperplasia compared with the normal jugular vein.Conclusion The method of anastomosis is successful and the model can mimic the pathology of human saphenous vein graft.