142例二尖瓣关闭不全患者行二尖瓣修复成形术的手术经验

Operation experience of mitral valvuloplasty with 142 mitral insufficiency

目的 分析、总结 14 2例行二尖瓣修复成形术的二尖瓣关闭不全患者的临床疗效。方法 1994年 1月～ 2 0 0 3年 12月 ,连续对 14 2例二尖瓣关闭不全患者行修复成形术 ,男 88例 ,女 5 4例 ,平均年龄为 (38.5± 7.8)岁。病因诊断 :二尖瓣腱索断裂 74例 ,二尖瓣黏液变性伴瓣叶脱垂 36例 ,冠心病二尖瓣乳头肌功能不全15例 ,二尖瓣瓣环扩大 11例 ,感染性心内膜炎伴二尖瓣穿孔 4例 ,扩张型心肌病伴二尖瓣关闭不全 2例 ;7例患者合并非风湿性主动脉瓣病变。手术在体外循环、中低温下施行 ,采用瓣叶切除缝合、瓣环成形、穿孔修补、腱索转移、edgetoedge技术及人工腱索成形技术 ,术中以食道超声监测成形效果。 结果 死亡 2例 ,1例术后第 6天死于脑出血 ,另 1例术后第 5天死于多器官功能衰竭。 5例患者术中转为瓣膜置换手术 ;其余患者术毕二尖瓣无返流或轻度返流。在平均为 (34.5± 4 .8)个月的随访中 ,有 2例二尖瓣返流加剧至中度而行二尖瓣置换手术。其余患者二尖瓣返流未见加剧 ,心功能恢复良好。结论 选择适当的患者、运用合理的瓣膜成形技术 ,二尖瓣关闭不全患者行瓣膜成形术可取得满意的疗效。

Objective To summarize and analize the clinical effect of 142 mitral i nsufficiency treated with mitral valvuloplasty. Methods Between January 1994 and December 2003, 142 consecutive patients,88 male and 54 female, with mitral ins ufficiency undertook mitral valvuloplasty at our center. The mean age was (38.5 ± 7.8) years. Preoperative diagnosis included degenerative mitral prolapse or chor dae r upture in 110 patients, ischemic mitral papillary muscle dysfunction in 15, annu lar enlargement in 11, endocarditis with leaflet perforation in 4, dilated cardi omyopathy in 2. All operations were performed under extracorporeal circulation, moderate hypothermia and under the surveillance of transesophagus echocardiograp hy. Valvuloplasty technique included sliding technique, annuloplasty, repair of perforation, chordal transfer, edge to edge technique and artificial chordae. Results 2 patients died with one of cerebral hemorrhage and the other of multiple organs failure during the first one postoperative week. 5 patients failed to repair an d received valve replacement afterward. Echocardiography demonstrated absence of mitral regurgita tion in 41 patients, trivial regurgitation in 82 and mild regurgitation in 12. D uring the follow-up with mean period of 34.5 months, 2 patients with late recur r ent mitral regurgitation aggravating to moderate degree of required valve replac ement. Others demonstrated no progress of mitral regurgitation with well recover y of cardiac function. Conclusion With proper vavuloplasty technique, selective mitral insufficient patients shoul d achieve satisfying effect.