Influence of surgery on the natural history of rheumatic mitral and aortic valve disease.
Influence of surgery on the natural history of rheumatic mitral and aortic valve disease.
复制标题
手术对风湿性二尖瓣和主动脉瓣疾病自然史的影响。
DOI：
10.1016/0002-9149(75)90007-7
复制
发表时间：
1975
影响因子：
2.8
通讯作者：
Omar Medina
中科院分区：
文献类型：
--
作者：
S. Muñoz;J. Gallardo;Jose R. Diaz;Omar Medina
本文对410例风湿性二尖瓣或主动脉瓣病变患者的5年生存率、心脏功能状态的演变和主要并发症的发生率进行了研究。不同类型风湿性二尖瓣疾病患者的5年生存率相似（二尖瓣狭窄患者为45%，二尖瓣关闭不全或二尖瓣关闭不全和狭窄混合患者为46%）。主动脉瓣疾病患者的生存率更有利（64%），二尖瓣切开术对死亡率的影响最大。接受该手术的患者的5年生存率为85%，明显高于药物治疗的二尖瓣狭窄患者。在接受二尖瓣和主动脉瓣置换术的患者中，与相应药物治疗组的数据相比，生存率也有所改善，但程度较低（主动脉瓣置换术为70%，二尖瓣置换术为60%）。在所有手术治疗组中，初次手术死亡率是5年生存率的主要决定因素，所有手术组的生存者心功能分级均有明显改善，心力衰竭和房颤的发生率显著降低。与药物治疗的二尖瓣狭窄患者相比，二尖瓣切开术后感染性心内膜炎的发生率显著降低。二尖瓣和主动脉瓣置换术并没有降低感染性心内膜炎的发生率。二尖瓣切开术和主动脉瓣置换术对血栓栓塞现象的发生率有有利影响，但二尖瓣置换术对血栓栓塞现象的发生率无影响。
The rate of survival, the evolution of functional cardiac status and the incidence of major complications during a 5 year period were studied in 410 patients with rheumatic mitral or aortic valve disease, of whom 200 were treated medically and 210 by surgery. The 5 year survival rates in patients with various types of rheumatic mitral valve disease were similar (45 percent for those with mitral stenosis and 46 percent for those with mitral insufficiency or mixed mitral insufficiency and stenosis). The survival rate in patients with aortic valve disease was somewhat more favorable (64 percent).Mitral valvulotomy had the most positive influence on mortality. The 85 percent 5 year survival rate of patients who underwent this procedure was significantly higher than that of patients with medically treated mitral stenosis. In patients submitted to mitral and aortic valve replacement, the survival rate was also improved in comparison with data in the corresponding medically treated groups, but to a lesser degree (70 percent for aortic valve replacement and 60 percent for mitral valve replacement). In all surgically treated groups, initial operative mortality was the primary determinant of the rate of survival at the end of 5 years.Survivors of all surgical groups had appreciable improvement in cardiac functional classification and a remarkable reduction in the incidence of heart failure and atrial fibrillation. The incidence of infectious endocarditis was significantly reduced after mitral valvulotomy, as compared with the incidence in patients with medically treated mitral stenosis. Mitral and aortic valve replacement did not reduce the incidence of infectious endocarditis. The incidence of thromboembolic phenomena was favorably influenced by mitral valvulotomy and aortic valve replacement, but not by mitral valve replacement.