球囊瓣膜成形术后二尖瓣瓣膜病变复发的外科治疗

Surgical experience for late recurrent mitral valvular heart disease after percutaneous balloon mitral valvotomy

目的总结球囊瓣膜成形术后二尖瓣瓣膜病变复发的外科治疗经验。方法回顾性分析我院1998年1月至2006年1月外科治疗的51例球囊瓣膜成形术后二尖瓣瓣膜病变复发患者的临床资料,并行二尖瓣置换术,就其病理改变、手术适应证及手术方法进行讨论。结果术中二尖瓣局部病理改变如下:交界硬化融合型3例,后瓣钙化卷缩型8例,交界钙化融合型34例,瓣膜与瓣下结构钙化型6例。术后早期死亡2例,死亡原因分别为低心排出量综合征和多脏器功能衰竭。46例患者术后获得6个月～7年的随访,随访率为90．2%,术后6个月随访时心功能均有不同程度改善。结论球囊瓣膜成形术后二尖瓣瓣膜病变复发以二尖瓣狭窄为主,外科治疗应以瓣膜置换术为宜,合并主动脉瓣及三尖瓣病变应同期积极手术纠正。

Objective To summarize our clinical experience in the patients with late recurrent valvular heart disease after percutaneous balloon mitral valvotomy （PMBV）. Methods The clinical data of 51 patients with late recurrent valvular heart disease after PMBV （Jan. 1998 to Jan. 2006） were retrospectively analyzed. Mitral valve replacements were preformed in all patients. The pathological changes, operation indications and operation methods were discussed. Results Forty-nine patients survived the operation. One patient died of low cardiac output syndrome, 1 died of MOF, with a mortality rate of 3.9% （2/51）. Forty-six patients were followed up for 3 month to 6 years. The follow-up results the cardiac function of patients were improved 6 months later. Conclusion Recurrent mitral valve disease after PBMV is dominately mitral valve stenosis. Mitral valve replacement should be recommended when there is recurrent mitral valve disease after PMBV. Presence of tricuspid and aortic valvular lesions should be corrected at the same time. （Shanghai Med J, 2007, 30：428-430）