心脏瓣膜置换术后死亡案例的法医病理学分析

【】　目的　分析心脏瓣膜置换术后死亡案例的法医病理学特点，探讨有关瓣膜置换术后死亡案例的法医病理学鉴定思路及原则。　方法　从手术方式、术前心脏状况及术中所见、法医病理检验所见、死亡时间、死亡原因等方面，对2008年1月-2010年2月4例心脏瓣膜置换术后死亡案例进行综合研究分析。　结果　4例均患有风湿性心脏病，且术前心功能较差；3例二尖瓣瓣膜置换术，3例主动脉瓣瓣膜置换术，2例三尖瓣成形术；二尖瓣瓣膜置换术1例平行房间沟的左房纵行切口，1例右心房-房间隔切口，1例右心房-房间隔-左房联合切口；主动脉瓣瓣膜置换术均行升主动脉根部斜形切口或S状切口；死亡时间为1例术中，1例术后30min，1例术后2d，1例术后8d；死亡原因为1例心肌炎，1例传导系统出血，2例失血性休克；1例术前有潜在感染灶。　结论　对有关心脏瓣膜置换术后死亡案例的法医病理学鉴定时，应在了解患者瓣膜置换术前心脏情况以及手术方式、手术路径和缝合方法的基础上，结合法医病理组织学检查进行综合分析。？【Abstract】　Objective　Toanalyzetheforensicpathologicalcharacteristicsofthosewhodiedaftercardiacvalvereplacementandexplorethementalityandprincipleofdocumentaryevidenceofmedicolegalexpertise.　Methods　FourdeathcasesaftercardiacvalvereplacementbetweenJanuary2008andFebruary2010werecomprehensivelyanalyzedfromvariousaspectsofsurgerystyle,preoperationalheartcondition,peri-operationalobservations,resultsofforensicpathologicaltests,timeofdeath,andcausesofdeath.　Results　Allcaseswererheumaticheartdiseaseandthepreoperationalheartfunctionwaspoor.Ofthefourcases,threehadmitralvalvereplacement(MVR),threehadaorticvalvereplacement(AVR)andtwohadtricuspidvalvuloplasty.OfthethreeMVRcases,cuttingontheleftatriumparallelingtheinteratrialgroovewasperformedinonecase,cuttingthroughrightatriumandinterauricularseptumwasperformedinonecase,andcuttingleftatriumandrightatriumthroughinterauricularseptumwasperformedinanothercase.ForallthethreeAVRcases,cuttingontherootofaortawiththeshapeofdiagonalor’S’wascarriedout.Onepatientdiedduringoperation,onediedthirtyminutesafteroperation,onediedtwodaysafteroperationandonediedeightdaysafteroperation.Amongthem,onediedofmyocarditis,onediedofhemorrhageintheconductingsystemandtwodiedofhemorrhagicshock.Besides,onepatienthadpotentialbacterialinfectionbeforesurgery.　Conclusion　Forpatientswhodiedaftercardiacvalvereplacement,weshouldacquaintanceourselveswiththepreoperationalheartcondition,surgerystyle,surgicalapproachandthemethodsofstitchtomakeacomprehensiveanalysiswithforensicpathologyexamination.？