二尖瓣环成形术后缺血性二尖瓣反流再发的机制探讨

Investigation on the mechanism of recurrent regurgitation after annuloplasty for ischemic mitral regurgitation

目的通过对二尖瓣形态学改变与二尖瓣反流程度相关性的研究，探讨二尖瓣环成形术后缺血性二尖瓣反流的再发机制。方法连续对31例行二尖瓣环成形术的缺血性二尖瓣反流患者手术前后进行标准的超声心动图检查。观察指标包括：二尖瓣关闭点心尖方向、前后方向位移，前后叶的关闭角度和活动度。结果31例患者二尖瓣环成形术后6例再发二尖瓣反流。后叶受牵拉增强是术后缺血性二尖瓣反流的独立决定因素。结论二尖瓣环成形术后的缺血性二尖瓣反流再发是前后叶同时受累，后叶受到的牵拉程度明显增强起主要的决定作用。

Objective To investigate relationships between leaflet configurations and persistent ischemic mitral valve regurgitation（MR） and to understand the mechanism of recurrent ischemic MR after the surgery. Methods In 31 consecutive patients with surgical annuloplasty for ischemic MR and 20 controls, posterior and apical displacement of the leaflet coaptation, the anterior leaflet（AML） and posterior leaflet（PML） tethering angles and the MR grade were quantified before and early after the surgery by echocardiography. Results Six of 31（19%） patients showed persistent MR despite annuloplasty. Increased PML tethering was the independent determinants for persistent ischemic MR after the annuloplasty. Conclusions Both leaflets tethering but with predominant contribution from PML tethering is related to recurrent ischemic MR after the annuloplasty.