瓣中瓣置入术治疗二尖瓣关闭不全16例报告

Intravalvular implantation of mitral valve prosthesis for mitral regurgitation in 16 cases

二尖瓣关闭不全患者行常规二尖瓣置换术后常有左室功能恶化，有人推测术中二尖瓣结构的破坏是导致术后左室功能不全的主要机制之一。从１９９１年５月～１９９５年５月，我们对１６例二尖瓣关闭不全患者实施了一种新的二尖瓣置换术，即“瓣中瓣”置入术。术中保留全部二尖瓣瓣叶及瓣下结构，人工瓣置入固定后，前、后瓣叶均卷缩折叠于缝合环下。术后所有患者病情平稳，仅３例需要很少量的正性肌力药物支持，且都能在术后３６小时内脱离呼吸机。经超声心动图测定，术后左室功能很快恢复，所有患者均痊愈出院。结果表明：对二尖瓣关闭不全及其合并轻度狭窄者采用瓣中瓣置入术，有利于术后左室功能的恢复，瓣中瓣置入术是一种安全和有效的手术方法。

Left ventricular (LV) function may often deteriorate after conventional mitral valve replacement in treating mitral regurgitation. It has been postulated that disruption of the mitral valve apparatus at operation is one of the major mechanisms for postoperative LV dysfunction. From May 1991 to May 1995, 16 patients with mitral regurgitation and poor preoperative heart function underwent mitral valve replacement with a new technique of intravalvular implantation of mitral valve prosthesis. During operation, the mitral leaflets and the subvalvular structure were wholly preserved. When the sutures were tied over the prosthetic sewing ring both the anterior and posterior leaflets were rolled up under the sewing ring. The postoperative courses were remarkably uneventful in all patients, with only very limited need of inotropic support in three. Spontaneous respiration was resumed within the first 36 hours after operation. Left ventricular function, which was measured by echocardiography postoperatively, recovered rapidly. All the patients survived and were discharged. The results seemed to indicate that mitral valve replacement with intravalvular implantation of mitral valve prosthesis may improve left ventricular function at least early after surgery in patients with simplex mitral regurgitation or even those accompanied by mild mitral stenosis. Intravalvular implantation of mitral valve prosthesis is a kind of safe and efficient surgical technique.