“缘对缘”术治疗Barlow病引发的二尖瓣关闭不全

The “edge to edge” technique: the treatment of mitral regurgitation caused by Barlow's disease

目的探讨“缘对缘”(edge-to-edge)技术治疗Barlow病(Barlow’sdisease)引起的二尖瓣关闭不全的有效性及安全性。方法2000年4月至2005年4月采用“缘对缘”术式治疗14例Barlow病病人,观察术前术后二尖瓣反流量、术后瓣口面积、左室流出道流速、跨瓣压差及心功能状态等相关指标变化。结果无围术期死亡。术中、术后1周心脏超声检查显示9例二尖瓣微量反流,5例轻度反流。术前6例左室流出道流速(116.33±5.05)cm/s,术后1周(107.17±10.23)cm/s(P>0.05)。14例随访1~60个月,平均26.8个月;无死亡及二次手术。术后二尖瓣瓣口平均面积为(3.00±0.57)cm2;跨瓣压差术前(8.13±4.49)mmHg(1mmHg=0.133kPa),术后(6.25±3.82)mmHg(P=0.050)。8例二尖瓣微量反流,6例轻度反流。术后心功能均恢复至I^II级。结论“缘对缘”术是治疗Barlow病导致二尖瓣关闭不全的一种简单易行且安全有效的手术方式,但远期疗效尚需进一步观察。

Objective To study the effect and safety of the ＂edge-to-edge＂ technique for the mitral regurgitation caused by Barlow＇s disease. Methods 14 patients with Barlow＇s disease received ＂edge-to-edge＂ operation from April 2000 to April 2005. The reflux amount pre- and postoperatively, the postoperative mitral annulus area, the outflow velocity of left ventricular outlet, and the parameters of cardiac function were studied. Results There was no perioperative death. The ultrasonic exams during and after operation showed that 9 cases had minimal reflux and 5 cases had slight reflux. The result of outflow velocity of 6 cases was （116.33 ±5.05） ends preoperatively and （ 107.17 ± 10.23）cngs postoperatively （ P 〉 0.05）. Follow-up of 14 patients was from 1 to 60 months （the mean value is 26. 8 months）. There was no late death and re-operation. The average mitral annulus area is （3.00± 0.57） cm^2. The transmittal pressure gradient decreased from （8.13 ± 4.49） mmHg to （6.25 ±3.82） mmHg after operation （ P = 0.050）. There were eight cases with minimal reflux and 6 cases with slight reflux. In all patients, the heart function returned to NYHA Ⅰ～Ⅱ grade. The ＂edge-to-edge＂ technique is a feasible and effective operation for treatment of the mitral regurgitation caused by Barlow＇ s disease.