二尖瓣替换术保留后瓣及腱索乳头肌（附53例报告）

Mitral valve replacement with preservation of papillary muscles and chordae tendineae:a report of 53 cases

对５３例心脏瓣膜病患者采用保留后瓣和腱索乳头肌二尖瓣替换术，其中二尖瓣和主动脉瓣双瓣替换术１７例，二尖瓣替换术３６例，同期行三尖瓣成形术２８例。术后１个月心脏超声检查结果显示，其左心功能指标明显优于同期行常规二尖瓣替换术者。其中ＳＶＩ、ＥＦ和ＦＳ改善明显，人造瓣膜碟片启闭速度加快、室隔矛盾运动消失。随访２个月至３年半，平均２年１个月，均长期生存。术后半年心脏超声复查结果表明左心功能ＥＳＶＩ、ＳＶＩ、ＥＦ、Ｆｓ较常规二尖瓣替换术者恢复更快，远期效果佳。作者对保留二尖瓣后瓣及瓣下结构的理论依据、适应证、具体操作技术及效果进行了讨论。

Abstract Mitral valve replacement with preservation of papillary muscles andchordae tendineae(MVRP)was car- ried out in 53 cases in this group,among whom 17 un- derwent combined mitral and aortic valve replacement(AVR),36 underwent simple mitral valve replacement(MVR) and tricuspid valve plasty was performed in 28cases simuItaneously,All the petients were given e- chocardiography one and six months after operation re- spectively which showed :(1) The left ventrical func- tion of this group was obviously superior to that of the conventional mitral valve replacement (MVRC)group in the same period(SVI, EF, FS,P<0. 05)(2)Theopen shut velocity of the prosthetic disc was quicker(3 ) The contradictory movement of the ventrical sep-tum disappeared.The follow-up for 2 to 36 monthsshowed that all the patients were alive and healthy. Itis suggested that MVRP can facilitate better recoveryof the left ventrical function than MVRC and long-termresults are excellent.