保留二尖瓣后瓣下结构的二尖瓣置换术对左室构型及功能的影响

The Configuration and Function of Left Ventricle after Mitral Valve Replacement with Subvalvular Preservation

目的评价保留二尖瓣后瓣下结构的二尖瓣置换术对左室构型及功能的影响。方法选择因慢性风湿性心瓣膜病而行二尖瓣置换术(MVR)者79例,其中保留二尖瓣后瓣下结构组(MVRP)40例,不保留二尖瓣后瓣下结构组(MVRNP)39例,再根据病因不同分为二尖瓣狭窄(MS)组29例(MVRP 14例,MVRNP 15例),二尖瓣关闭不全(MI)组27例(MVRP 15例,MVRNP 12例)和双瓣置换术(DVR)组23例(MVRP 11例,MVRNP12例)。分别于术前、术后7 d和3月三维超声测量左房面积(LAA)、左室短轴缩短率(FS)、左室舒张期末容积(LVEDV)及收缩期末容积(LVESV),并计算左室射血分数(LVEF)。结果术后3月,MVRP组MI及DVR患者FS、LVESV、LVEF、LAA及LVEDV优于MVRNP组(P<0.05);两组MS患者差别无统计学意义(P>0.05);MVRP组左室构型呈椭圆形,MVRNP组呈偏心形或圆形。结论与不保留二尖瓣后瓣下结构的MVR术比较,保留二尖瓣后瓣瓣下结构的MVR术对于MI、DVR患者更有利于改善左室构型及左室功能。

Objective To make an evaluation of the effect of mitral valve replacement（MVR） with the subvalvular preservation on the configuration and function of left ventricle. Methods 79 patients with chronic rheumatic valvular disease were taken and divided into two groups according to the form of operations; the mitral valve subvalvular preservation（MVRP） group（n= 40） and the non- preservation （MVRNP） group（n=39）. The mitral valve stenosis（MS） group was 29 cases（including 14 MVRP and 15 MVRNP）, the mitral incompetence（MI） group was 27 cases（including 15 MVRP and 12 MVRNP）, and the double valve replacement（DVR）group was 23 cases（including 11 MVRP and 12 MVRNP）. The left atria area（LAA）, fractional shortening（FS）, left ventricular end-diastolic volume（LVEDV） and left ventricle end-systolic volume（LVESV） before 7 days and 3 months after the operation were measured with 3D ultrasonometry and the ejection fraction was calculated, respectively. Results The FS, LVESV and LVEF of patients in MI and DVR subgroups in MVRP group were more ameliorated than that in MVRNP group（P〈0.05） 3 months after the operation. The LAA and LVEDV of patients in MI and DVR subgroups in MVRP group were more ameliorated than in MVRNP group（P〈0.05） 3 months after the operation. The configuration in MVRP group of MI and DVR 3 months after operations was oval-shap, but in MVRNP group was off-center or even globular, although was no significant difference in MS patients between MVRP and MVRNP groups（P〉0.05） 3 months after the operation. Conclusion The operation of posterior subvalvular preservation are more favorable in improving the configuration and function of left ventricle for MI and DVR patients.