自体三尖瓣后叶材料在主动脉瓣和二尖瓣成形术中的初步临床应用

Preliminary Res ults of Aortic and Mitral Valvuloplaty Using the Tricuspid Posterior Leaflet

目的 :探索利用患者自体三尖瓣后叶进行二尖瓣和主动脉瓣成形术的技术可行性。 方法 :2 0 0 2年 7月～ 2 0 0 4年 7月 ,13例患者接受了用自体三尖瓣后叶瓣膜成形手术。二尖瓣成形术 6例 ,主动脉瓣成形术 7例 ,男 9例 ,女 4例 ,平均年龄 (2 9 7± 11 3 )岁。体外循环下剪除并修整三尖瓣后叶 ,作为成形材料进行二尖瓣或主动脉瓣成形。 结果 :术后 1周复查超声心动图 ,二尖瓣成形患者的左心房前后径、左心室舒张末期内径及射血分数值较术前均显著减小 (P <0 0 5 )。平均随访 (11 4± 1 6)月后 ,主动脉瓣成形患者的左心室舒张末期内径较术前显著减小 (P <0 0 5 ) ,术中食道超声及术后随访超声心动图均未探及三尖瓣狭窄和关闭不全的存在。 结论 :自体三尖瓣后叶装置作为重建材料进行主动脉瓣或二尖瓣成形术 ,近期效果良好 ,取材后的三尖瓣功能完好 ,为瓣膜成形术提供了一种新的术式。

Objective:To e plore the technical ea ibility o aortic and mitral valvulopla ty u ing the tricu pid po terior lea let. Method : rom July 2002 to July 2004,13 patient underwent aortic or mitral valvulopla ty by u ing the tricu pid po terior lea let,including 9 male and 4 emale with an average age o 29 7±11 3 year .The po terior lea let o tricu pid valve wa harve ted under cardiopulmonary bypa and u ed in aortic or mitral valve repair. Re ult :At 7 po toperative day ,the le t ventricular ejection raction (E ) in aortic valvulopla ty patient decrea ed igni icantly ( p Z <0 05) on echocardiography,and o did the le t atrial diameter,le t ventricular end dia tolic diameter (LVEDD) B Q and E in the mitral valvulopla ty patient ( p<0 05) . A ter a mean ollow up o 11 4±1 6 month ,a igni icant reduction o LVEDD in the aortic valvulopla ty patient wa detected on echocardiography.The tricu pid valve were ound to have no in u iciency and teno i on intra ,po toperative and ollow up echocardiography. Conclu ion : avorable hort term re ult were achieved with thi new procedure or mitral and aortic valve repair urgery.The tricu pid valve wa unctionally intact a ter the po terior lea let being harvested.