Rheumatic heart disease in critically ill surgical treatment

• Author: admin
• Filed under: Heart disease
• Date: Nov 15,2008

1. Perioperative Management

Critical rheumatic heart valve Bingti long-term cycle of the circulatory system and pulmonary hypertension, congestion, the occurrence of lung, liver, kidney and other major organ dysfunction; due to the long-term gastrointestinal mucosa system congestion, caused by poor digestion and absorption function, patients with cardiac cachexia . Therefore, preoperative cardiac function should be strengthened to support and even intravenous inotropic drugs, pre-operative patients to improve heart function, the importation of plasma, fresh blood, such as albumin, to correct the patient’s anemia and hypoproteinemia; for lung Functional exercise. General failure to be corrected to improve the nutritional status, the choice to adapt the timing of surgery to enhance the efficacy of surgery. Surgical myocardial protection using machine potassium blood cardioplegia infusion, to ensure that the myocardial oxygen supply and energy metabolism, prevent myocardial reperfusion injury. Serious postoperative low cardiac output, with the exception of positive inotropic drugs, early use of intra-aortic balloon pump, left heart bypass to improve left ventricular function; renal failure patients in the early line of bedside blood dialysis or peritoneal dialysis ; Intubated patients can not eat by mouth as soon as possible through nasal feeding or intravenous nutrition, enabling patients to resume.

2. Membrane disease treatment

Rheumatic heart disease patients, a considerable number of functional tricuspid valve insufficiency, the effects of post-operative heart function and long-term survival, therefore, should take a more aggressive surgical approach to replace the mitral valve, aortic valve, That is, slightly more than for functional tricuspid valve insufficiency, but also for the flap hang reduction surgery. Avoid early postoperative lesions increased occurrence of right heart failure.

3. To strengthen the post-operative visits and treatment

Rheumatic heart disease in critically ill after the operation to restore heart function is a bad one of the leading causes of death. According to the observation by the performance of the heart failure was systemic venous system congestion, Nuzhang jugular vein, hepatosplenomegaly, severe cases, the emergence of lower extremity edema. Drugs can only alleviate the short-term, high-operative complications and mortality. As a result, post-operative patient follow-up to be on a regular basis, so Doppler echocardiography, the early detection of tricuspid valve insufficiency, and timely treatment.

4. Postoperative patients with early complications, according to the frequency followed by low cardiac output syndrome, ventricular arrhythmia, renal failure, and so on. Application of post-operative inotropic drugs and the expansion of drug treatment of vascular low cardiac output syndrome; to correct hypokalemia, such as electrolyte imbalance, to correct ventricular arrhythmias; renal failure patients at an early stage line bedside blood dialysis or peritoneal dialysis.

5. The latter part of the major complications of brain hemorrhage, cerebral embolism, mechanical card flap valve, functional tricuspid valve insufficiency, and so on. The prevention of cerebral hemorrhage and cerebral embolism, the key is to guide patients to take anticoagulant drugs at the same time do a good follow-up work on a regular basis for testing prothrombin time and international standards to adjust the ratio of anticoagulant applications. There are cases of epilepsy occur, and this led to the excessive anti-coagulation factors related to cerebral hemorrhage.

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