【摘要】 目的　总结先天性心脏病合并二尖瓣关闭不全患者的二尖瓣成形手术方法和临床效果。　方法　 112例先天性心脏病患者主要病种为房室间隔缺损 2 9例、室间隔缺损 2 5例、动脉导管未闭 14例、房间隔缺损 14例等 ,合并二尖瓣关闭不全的主要病理改变为瓣环扩大 5 8例、瓣叶裂隙 37例、前、后瓣叶脱垂 36例等。二尖瓣成形方法为瓣叶裂隙缝合 34例 ,Cosgrove环环缩瓣环 2 2例 ,交界环缩 18例 ,双孔法 14例等。术中左心室注水观察、评价成形后二尖瓣反流程度 ,脱离体外循环后食管超声心动图观察成形结果。　结果　全组无死亡 ,1例因人工腱索断裂行二尖瓣置换术 ,术后门诊随访二尖瓣反流 0～ 级 72例 , 级 2 6例。术前左心室舒张期末直径大于或等于 4 5 mm6 2例 ,术后随访左心房、左心室缩小 ,与术前比较差别有显著性意义 (t=6 .5 3,7.89,P<0 .0 0 1)。　结论　先天性心脏病合并二尖瓣关闭不全病理改变较多 ,根据不同病理改变采取相应的二尖瓣成形方法 ,甚至需要同时采用多种措施才能获得满意效果 ;术中行食管超声心动图能为判断手术效果提供有益的帮助更多还原

【Abstract】 Objective To study the clinical results and operative methods of mitral valvoplasty in patients of congenital heart disease with mitral insufficiency. Methods One hundred and twelve patients of congenital heart disease with mitral insufficiency had been treated with valve repair procedure. The surgery was performed under extracorporeal circulation and moderate hypothermia. Most of the patients were diagnosed atrioventricular septal defects (29 cases), ventricular septal defect (25 cases), patent ductus arteriosus (14 cases), and atrial septal defect (14 cases) before operation. The main pathologic characters of mitral valve were mitral valve annular dilatation (58 cases), leaflet lesions (37cases), anterior and posterior leaflet prolapse (36 cases). The surgery consisted of complex methods to repair mitral valves, including rings annuloplasty (22 cases), closure of the commissure (18 cases), double-orifice method (14 cases), chords reimplantation and so on. Results Seventy two patients had 0 to I class mitral valve regurgitation and 26 patients had Ⅱ class mitral valve regurgitation during the retrial period by echocardiography, only one case needed re-operation. The patients with left ventricular end diastolic diameter (LVEDD) more than 45mm had a reduction of left atrial diameter (from 45.8±10.7mm to 34.4±8.9mm, t=6.53, 7.89,(P<)0.001) and left ventricular diameter (from 58.6±10.9 mm to 44.3±8.5 mm, t=7.89, P<0.001) after operation. Conclusions Surgical operation on mitral valve regurgitation of congenital heart defect is a benefit and a compound method and transesophageal echocardiography may help the surgeon in estimating the surgical efficacy during operation.更多还原