Critical of rheumatic valvular heart disease treatment

Methods 1. Giving cardiac preoperative diuretic, and so improve the heart function, blood transfusion, albumin, and so improve nutrition, treatment of 21-65 days. There are three cases of patients admitted to hospital within 48 hours of acute cardiac insufficiency emergency operation. 2. The whole group were 49 cases of patients in general anesthesia, low temperature, a cardiopulmonary bypass surgery, 12 cases of myocardial protection by the former 4 ° C cold crystalloid cardioplegia solution; 1:4 after 37 cases using potassium content of blood cardioplegia solution continuous perfusion, myocardial surface vapor cooling. Mitral valve replacement using 2-0 prolene continuous suture line, after reservations under the flap valve and the structure. Aortic valve replacement using aortic root oblique incision, using interrupted suture - suture. Tricuspid regurgitation were Devega Central Bank of or reduction of shrinkage kay ring. Results The 49 cases of early postoperative patient died 10 cases. One died after six cases of low cardiac output syndrome, two cases of death due to ventricular fibrillation treatment ineffective; One died of renal failure; One died of intracranial hemorrhage; Total mortality 20.41%. Long-term survival in 39 cases. Follow-up time, June 12. Follow-up rate of 100%. One patient died of intracranial hemorrhage three years. After 1 1 cases of endocarditis in two deaths; One case of six after one year left on the right side limbs cerebral embolism activities obstacles; After three years, one case of mechanical valves card flap death; One case of cerebral hemorrhage after 2-year legacy of epilepsy. Follow-up on the five-year survival rate has been 86.92%. Central to the same period tricuspid shrinkage of patients, follow-up found 10 cases are mild regurgitation, five cases of the closure of a moderate insufficiency, cardiac diuretic treatment required. Conclusion 1. Perioperative Management Critical rheumatic heart valve and lung Regenerated cycle of long-term high-pressure circulation system, congestion, in the lung, liver, kidney and other major organ dysfunction; Due to long-term congestion gastrointestinal mucosa caused digestion and absorption features low, evil heart of patients with quality. Therefore preoperative cardiac function should be strengthened support, and even intravenous drip positive inotropic drugs, the patient's preoperative cardiac function improved conditions, the importation of plasma, fresh blood, albumin, and so on, the correct patients with hypoproteinemia anemia; Pulmonary function conducted training. Heart failure generally to be corrected, improved nutritional status, to choose the timing of surgery to improve surgical treatment. Use of myocardial protection potassium content of blood cardioplegia solution continuous perfusion, thus ensuring the myocardial oxygen supply and energy metabolism, prevent myocardial reperfusion injury. After severe low cardiac output, in addition to positive inotropic drugs, the early adopters IABP, left ventricular bypass can improve left ventricular function; Renal failure patients early trip bedside peritoneal dialysis or hemodialysis; Tracheal intubation of patients can not eat by mouth early supplementary nutrition through nasal feeding or intravenous nutrition, favorable patient recovery. 2. Membrane Disease Treatment Rheumatic heart valve disease, a considerable number of patients in functional closed tricuspid valve insufficiency, cardiac function and postoperative effects of long-term survival, therefore, should take positive surgical approach, in replacement of mitral valve, aortic valve at the same time, that is more than functional mild tricuspid valve insufficiency, for reduction of the ring annuloplasty. Avoid early postoperative lesions increase in right ventricular failure. 3. Strengthening Prevention and Treatment with postoperative Critical rheumatic valvular heart disease cardiac functional recovery after surgery is the major cause of death bad one. According to observation, from heart failure for the performance of systemic venous blood stasis, jugular goats, hepatosplenomegaly, a serious lower extremity edema. Drugs can only temporary remission, re-operation complications and high mortality. Therefore, the importance of regular follow-up of patients, so Doppler echocardiography, early detection tricuspid regurgitation, timely treatment. 4. This group of early postoperative complications, according to the frequency followed by low cardiac output syndrome, ventricular arrhythmia, renal failure, and so on. After application of positive inotropic drugs and expansion of drug treatment of vascular low cardiac output syndrome; Correct hypokalemia, and other electrolyte imbalance to correct ventricular arrhythmias; Early renal failure patients bedside visit peritoneal dialysis or hemodialysis. 5. Late complications mainly cerebral hemorrhage, cerebral embolism, machinery card flap valve, the tricuspid valve insufficiency, and other functional closure. Prevention of cerebral hemorrhage and cerebral embolism, the key is to guide patients taking anticoagulant drugs, to do follow-up work at the same time, periodic testing prothrombin time ratio adjustment and international standards anticoagulant drug applications. The patients in one case of postoperative patients 2 years of epilepsy, and still lead to excessive anticoagulation related cerebral hemorrhage.