缺血性二尖瓣关闭不全的外科治疗

Surgical treatment of ischemic mitral regurgitation.

目的总结缺血性二尖瓣关闭不全的外科治疗经验.方法28例缺血性二尖瓣关闭不全的患者接受手术治疗,其中轻度返流10例,中度返流6例,重度返流12例.11例有心肌梗死史;术前左室舒张末径62.8±6.7mm,左房内径50.1±6.4mm,左室射血分数＞0.5 11例,0.3～0.5 17例.3例接受单纯冠状动脉旁路移植术(CABG),4例接受CABG加二尖瓣成形术(MVP),21例接受CABG加二尖瓣置换术(MVR).结果术后早期死亡4例,其余均痊愈出院.出院时患者心功能NYHA分级均为1～2级,术后早期超声心动图显示左室舒张末径和左房内径均较术前缩小(P＜0.05).结论中度以上的缺血性二尖瓣返流应手术处理,CABG+MVR是一种可靠的方法.

Objective To review the experience in surgical treatment of ischemic mitral regurgitation.Methods Twenty-eight patients with ischemic mitral regurgitation underwent surgical treatment. Ten cases was mildmitral regurgitation, 6 moderate and 12 severe. Before operation the average left ventricular end- diastolic diameter（LVEDD） was 62.8±6.7mm. The left atrial （LA） was 50.1±6.4mm. Three patients were treated with coronary artery bypass grafting （CABG） alone. Four patients were treated with CABG and mitral valveplasty （MVP）. 21 patients were treated with CABG and mitral valve replacement （MVR）. Results Four cases died early postoperatively. Others all were clinically asymptomatic. The cardiac function was class 1 - 2 （ NYHA）. Early postoperative LVEDD and LA was smaller than preoperative （ P 〈 0.05 ）. Conclusion Mitral valve surgery is indicated in patients with moderate or severe ischemic mitral regurgitation. CABG plus MVR is a feasible way。