目的：总结小左心室(左心室舒张末期内径≤40mm)风湿性心脏病患者的外科治疗经验。方法对292例风湿性心脏病患者行体外循环心脏直视手术治疗，其中3例患者合并小左心室，本文对此3例患者的临床资料进行回顾性分析。结果1例于术后第6天死于多器官功能衰竭，其余2例痊愈出院，心功能恢复至I～I 级。随访13～18个月，心脏彩超显示左心室舒张末期内径分别为45 mm和46 mm，左心室射血分数分别为0.78和0.76，均较术前改善(P＜0.05)。结论小左心室患者病程长，病情重，多合并三尖瓣关闭不全及肺动脉高压，晚期部分患者可发展为左心室萎缩及右心功能不全，手术风险大，死亡率高；重视围手术期处理，可以提高手术疗效。%Objective To summarize the surgical treatment experience of severe rheumatic mitral stenosis patient with small left ventricle (left ventricular end diastolic diameter≤ 40mm).Methods 292 cases of rheumatic heart disease patient including 3 cases of severe mitral stenosis patient with small left ventricle received open heart surgery by cardiopulmonary bypass. The clinical data of 3 cases of severe mitral stenosis patient with small left ventricle was analyzed retrospectively.Results 1 case died of multiple organ failure secondary to hypoxemia, pulmonary infection, low cardiac output syndrome and acute renal failure. The other 2 cases were cured and discharged, and their cardiac function recovered to grade I to II. During the following-up period with 13 to 18 months, left ventricular end diastolic diameter of 2 cases was respective 45mm and 46mm, and left ventricular ejection fraction was respective 0.78 and 0.76. The two indexes were improved compared with preoperative indexes.Conclusion Severe rheumatic mitral stenosis patient with small left ventricle usually associates with long duration, serious condition, tricuspid valve insufficiency and pulmonary arterial hypertension, even a part of patient develops into left ventricular atrophy and right heart insufficiency in advanced stage. So severe rheumatic mitral stenosis patient with small left ventricle has greater operation risk and higher mortality. If more attention was paid to perioperative treatment for severe rheumatic mitral stenosis patient with small left ventricle, the effect of operation could be improved.
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