冠状动脉旁路移植术对中度缺血性二尖瓣关闭不全的影响

Effect of coronary artery bypass grafting on moderate ischemic mitral valve regurgitation

目的评估行单纯冠状动脉旁路移植术(CABG)的中度缺血性二尖瓣关闭不全(IMR)患者的效果,以探讨最佳治疗方案。方法51例术前诊断为IMR的患者行单纯CABG术。分析术前术后以及随访期二尖瓣关闭不全的程度,左心室功能,左心室内径。结果30d手术病死率3.9%(2/51),手术后3周内复查超声显示无返流或轻微返流12例,轻度返流21例,中度返流16例。心功能Ⅰ、Ⅱ级者40例,Ⅲ级者9例。左心室内径较术前明显缩小(P<0.05),左心室功能较术前改善但无明显差异,31例(60.8%)二尖瓣关闭不全程度下降(P<0.01)。随访46例(93.9%),平均24个月。随访期间死亡1例。结论CABG术能降低大部分中度IMR患者的二尖瓣关闭不全程度,但对于并发充血性心力衰竭或左心室功能较低(射血分数<30%)的中度IMR患者,单纯CABG术可能并不是最佳的治疗方案,应积极处理二尖瓣关闭不全。

Objective To clarify the effect of isolated coronary artery bypass grafting （CABG） on moderate ischemic mitral valve regurgitation （IMR） and to evaluate the optimal management. Methods 51 patients with moderate IMR underwent isolated CABG. The grade of mitral valve regurgitation,left ventricular （LV） function and diameter of LV during preoperation,postoperation and period of follow-up. Results The 30-day operative mortality was 3.9% （2/51 ）. Within 3 weeks after CABG, only 16 patients continued to have moderate MR,21 patients with slight MR,and 12 patients with/without slight MR. The diameter of LV was significantly decreased （P 〈 0.05 ）, the left ventricular function was improved but not significantly changed and the decrease in MR grades was significant in 31 cases（60.8% ） （P 〈0.01 ） ,46 cases （93.9%） were fouowod up for 24 months and 1 case died durag follow-up period. Conclusion CABG can decrease the grade of MR for most moderate isehemic MR patients,but for patients with significant preoperative left ventricular dysfunction （ejection fraction 〈 30% ） and congestive heart failure, isolated CABG may not be the optimal therapy, so mitral valve regurgitation should be managed actively.