保留瓣下结构的二尖瓣替换术后早期效果观察

Early Results of Mitral Valve Replacement With Subvalvular Structure Preservation

目的：二尖瓣关闭不全患者行常规二尖瓣替换术后常有左心室功能恶化，有作者推测术中二尖瓣结构的破坏是导致术后左心室功能不全的主要原因之一。本文旨在探讨保留瓣下结构的影响。方法：总结了保留瓣下结构的二尖瓣替换术２６例，其中部分保留２２例为二尖瓣狭窄，完全保留４例为二尖瓣关闭不全。结果：与同期完全切除的２６例（均为二尖瓣狭窄）比较，保留瓣下结构者术后低心输出量综合征发生率较低，左心房缩小较明显，未发生左心室破裂。其余５项指标两组间无差异。结论：二尖瓣关闭不全者应完全保留瓣下结构，其中将人工瓣置入二尖瓣口内更为简便安全。部分二尖瓣狭窄者可保留后瓣及瓣下结构，而瓣叶和瓣下结构病变严重者则应完全切除。

Objective:Left ventricular function often deteriorates after conventional mitral valve replacement for mitral regurgitation.It has been postulated that disruption of the mitral valve apparatus at operation is a major cause of postoperative dysfunction.This study was aimed to study the result of subvalvular structure preservation in mitral valve replacement. Methods:Twenty six patients underwent mitral valve replacement in our hospital were studied,among them 22 with mitral stenosis underwent mitral valve replacement with partial subvalvular structure preservation and the rest with mitral insufficiency underwent mitral valve replacement with entire subvalvular structure preservation. Results:Comparing with another group of 26 patients(mitral stenosis) underwent mitral valve replacement with entire subvalvular structure resection,the patients with subvalvular structure preservation had much less postoperative low cardiac output complications,more left atrial dimension reduction and no occurrence of left ventricular rupture,but no significant difference in the other five measured indexes. Conclusions:This study suggests that for patients with mitral insufficiency mitral valve replacement with entire subvalvular structure preservation is preferable,while intravalvular implantation of mitral prosthesis is simpler and safer.Some of the patients with mitral stenosis should receive mitral valve replacement with posterior leaflet and subvalvular structure preservation,however for patients with severe lesion of the leaflets the entire subvalvular structure should be resected.