冠心病合并缺血性二尖瓣关闭不全的处理方法

Strategy in treating ischemic mitral regurgitation

目的 探讨冠心病合并缺血性二尖瓣关闭不全 (IMR)病例 ,在行冠状动脉旁路移植术(CABG)时是否要对二尖瓣进行处理及最合适的处理方法。方法 回顾分析 2 0 0 0年 1月至 2 0 0 3年 1 0月期间连续行CABG者中 37例合并IMR者在不同手术处理前后的变化。结果 术前合并有轻 -重度IMR者中 2 4例仅行CABG ,无手术死亡 ,术后 1周左室舒张直径由 5 2 95mm降至 4 8 1 8mm(P =0 0 0 1 ) ,左室射血分数从 0 46上升到 0 5 5 (P <0 0 0 1 ) ,二尖瓣反流面积 (MR)由 3 93cm2 下降至 1 48cm2 (P <0 0 0 1 ) ;1 3例同期行CABG和二尖瓣成形或置换 ,手术死亡 1例。结论 缺血性心脏病合并无二尖瓣明显病理结构改变的IMR ,单纯行再血管化后左心室收缩功能改善、IMR短期内明显减轻或消失。中度以上IMR并有二尖瓣发生病理结构改变时 ,需同期对二尖瓣进行干预 ,但是手术死亡率较高。

Objective To weight the proper treatment for ischemic mitral regurgitation (IMR) patients who require coronary artery bypass grafting (CABG). Patients and Methods 37 CABG patients with IMR during January 2001 and October 2003 were analyzed retrospectively. Results 24 patients underwent CABG alone, there were no operation mortality. The left ventricular diastolic diameter decreased from 52 95 mm to 48 18 mm (P=0 001), LVEF increased from 0 46 to 0 55 (P<0 001), IMR area decreased from 3 94 cm 2 to 0 99 cm 2 one week after operation. Thirteen patients underwent CABG and mitral valve repair or replacement, 1 died within 30 days. Conclusion Mild to moderate IMR without pathological structural change of mitral valve can be reversed by revascularization alone, this partly due to improving left ventricle contraction. IMR with annullar dilatation or structural destruction of mitral valve must be corrected by revascularization and mitral correction.