非缺血性二尖瓣关闭不全合并左心室功能受损患者外科治疗效果的临床分析

Surgical Treatment for Nonischemic Mitral Valve Regurgitation With Left Ventricular Dysfunction

目的:分析总结非缺血性二尖瓣关闭不全合并左心室功能受损患者手术治疗后早期和远期左心室舒张末内径(LVEDD)和左心室射血分数(LVEF)的变化,为手术适应证及手术方法的选择提供依据。方法:1999年1月至2005年12月,外科治疗46例LVEF≤0.55的非缺血性二尖瓣关闭不全患者,其中二尖瓣成形术21例,瓣膜置换术25例。使用二维超声测量术前、术后早期和随访期间LVEDD和LVEF。结果:全组无手术死亡。随访到42例,随访期死亡1例,生存者心功能改善。术后早期与术前比较,LVEDD从(67.02±9.83)mm缩小到(59.52±9.49)mm(P<0.05),LVEF从47.48±6.02提高到50.09±10.59(P>0.05)。随访期,LVEDD和LVEF分别为(59.46±13.28)mm和(53.79±14.00)mm,与术后早期相比均无显著性差异。但二尖瓣成形术后如无残留及再发反流,LVEF在随访期内可进一步提高,有显著性差异。结论:非缺血性二尖瓣关闭不全合并左心室功能受损的患者应积极手术治疗,术后早期患者左心室逆重塑,随访期不再继续恶化。手术方式的选择应综合考虑瓣膜病理改变、心功能及术者经验等因素,尽量施行瓣膜成形术。

Objective ：To evaluate the effects of surgical treatment on nonischemic mitral regurgitation with left ventricular dysfunction. Methods ：From January 1999 to December2005,46 patients（ EF≤0. 55 ） with nonischemic mitral valve regurgitation underwent mitral valve plasty （ MVP,21 ） or replacement （ MVR,25 ）. Results：There was no operative death. There was one late death. All other follow-up patients demonstrated well recovery with New York Heart Association classification. The post-operative left ventricular end-diastolic dimension（LVEDD） was significantly decreased [ 67.02 ± 9.83 mm to 59.52 ± 9.49 mm（ P 〈 0. 05 ） ] , at the meantime,left ventricular ejection fraction （LVEF） wasn＇ t significantly increased[47.48 ± 6.02 to 50. 09 ± 10. 59（ P 〉0. 05 ） ]. The follow-up LVEDD and LVEF were not changed significantly[ 59.46 ± 13.28 mm and 53.79 ± 14.00 mini. The follow-up LVEF was significantly increased in MVP group without residual regurgitation or recurrent regurgitation. Conclusion ：Nonischemic mitral regurgitation with left ventricular dysfunction should be treated aggressively. Operative technique should be based on valve pathology ,left ventricular function and experience of operator. Valve repair should be considered if possible.