【摘要】 目的 总结“缘对缘”联合人工瓣环修复二尖瓣成形术治疗二尖瓣关闭不全的手术效果。方法 回顾性分析2004年1月至2008年12月对42例非风湿性二尖瓣关闭不全患者行“缘对缘”联合人工瓣环修复二尖瓣成形术的临床资料,男性25例,女性17例,年龄12~69(36.42±14.28)岁。其中先天性二尖瓣病变12例,瓣膜退行性病变20例,缺血性二尖瓣关闭不全7例,感染性心内膜炎3例。术前心脏彩超提示:前叶病变27例,前叶+后叶病变17例;二尖瓣返流重度19例、中度至重度14例、中度返流9例。42例患者均在全身麻醉低温体外循环下应用“缘对缘”联合人工瓣环修复术进行二尖瓣成形术。术中应用250 ml注射器向左心室注冰盐水,观察评价成形后二尖瓣返流情况,脱离体外循环后经食管超声心动图观察成形结果 。分别测量术前及术后二尖瓣返流面积、二尖瓣开口面积、左房内径及左室舒张末期内径、左室射血分数,研究手术前后二尖瓣返流、心脏大小变化、心功能改善情况。结果 全组无死亡病例,出院时心脏功能(NYHA分级)Ⅰ级32例、Ⅱ级10例。随访39例,随访时间1~60(24.6±18.2)个月。超声心动图提示:术前二尖瓣返流面积为(11.0±3.8)cm2,术后1年无或微量返流13例、轻度返流17例、轻度至中度返流9例、轻度二尖瓣狭窄1例,返流面积为(4.1±1.4)cm2。术前二尖瓣开口面积(4.14±1.54)cm2,术后1年为(3.58±1.10)cm2。术前左心房内径为(48.6±12.4)mm,术后1年为(36.5±9.4)mm。术前左心室舒张末径为(64.3±11.4)mm,术后1年为(50.6±7.6)mm。术前左心室射血分数为(54.6±6.2)%,术后1年提高为(63.4±4.0)%。结论 “缘对缘”联合人工瓣环修复二尖瓣成形术治疗二尖瓣关闭不全手术方法 安全、有效,可获得良好的治疗效果。更多还原

【Abstract】 Objective To discuss the surgical results of association of edge-to-edge valve repair to artificial ring annuloplasty for mitral valve insufficiency.Methods The clinical files of 42 cases of non-rheumatoid mitral valve insufficiency treated by association of edge-to-edge valve repair to artificial ring annuloplasty from January 2004 to December 2008 were retrospectively reviewed.There were 25 male patients and 17 females,with age ranging from 12-69(36.42±14.28)years old.There were 12 cases of congenital mitral valve anomaly,20 degenerative valve disease,7 ischemic mitral valve insufficiency and 3 infective endocarditis.Pre-operation echocardiography revealed:anterior leaflet disease in 27,anterior and posterior leaflet disease in 17,severe mitral valve regurgitation in 19,moderate to severe mitral valve regurgitation in 14,moderate mitral valve regurgitation in 9.All 42 patients received artificial ring annuloplasty associated with edge-to-edge valve repair under routine general anesthesia and hypothermia.During the procedure,cold saline was injected into left ventricle using a 250 ml syringe in order to assess the degree of mitral valve regurgitation following the annuloplasty.After the patient was weaned from cardiopulmonary bypass,transesophageal echocardiography was used to evaluate the results of the annuloplasty.Pre- and post-operative mitral valve jet area,mitral valve orifice area,left atrial dimension and left ventricle dimension and left ventricle ejection fracture were measured.Data were analyzed using t test.Pre- and post-operative levels of mitral valve regurgitation,dimension of the heart and heart function were studied.Results There was no mortality.Upon discharge,there were 32 patients with NYHA class Ⅰ,10 Class Ⅱ.Thirty nine patients were followed-up,with foEow up duration ranging from 1-60(24.6±18.2)months.Echocardiography revealed that pre-operative mitral valve jet area was(11.0±3.8)cm2.One year post-operation,13 cases showed no or trace regurgitation,17 mild regurgitation,9 mild to moderate regurgitation,1 mild mitral valve stenosis,mitral valve jet area(4.1±1.4)cm2.Pre-operative mitral valve orifice area was(4.1±1.4)cm2,and(3.58±1.10)cm2 at one year post-operation.Left atrial dimension was(48.6±12.4)mm before the operation and(36.5±9.4)mm at one year post-operation.Left ventricle end diastolic dimension was(64.3±11.4)mm and(50.6±7.6)mm one year after the surgery.Left ventricle ejection fracture was(54.6±6.2)%and(63.4±4.0)%one year after the surgery.Conclusion Association of edge to edge valve repair to artificial ring annuloplasty for mitral valve insufficiency is safe and effective,leading to satisfactory surgical results.更多还原