巨大心脏患者二尖瓣成形手术疗效评价

Evaluation of Valve Reconstruction of Mitral Valve Insufficiency With Giant Heart

目的：总结巨大心脏患者单纯二尖瓣关闭不全施行二尖瓣成形手术的疗效。讨论影响手术疗效的主要危险因素及手术适应证的选择原则。方法：以左心室扩大指数将扩大的心脏分级，结合患者病理改变的类型，对３３例巨大心脏单纯二尖瓣关闭不全的患者行二尖瓣成形术，并对其近、远期结果进行回顾性总结。结果：病理改变为单纯瓣环扩大５例；合并瓣叶脱垂２２例，其中腱索过长１８例，腱索断裂５例，腱索缺如１例，瓣叶裂隙４例；合并瓣叶增厚、腱索乳头肌融合６例。成形方法为单纯瓣环成形９例，合并腱索缩短１１例，脱垂部分切除缝合７例，腱索移植１例，乳头肌切开腱索松解３例，瓣叶裂隙缝合４例，放置人工成形环１４例。术后早期死亡８例（２４．２％）。结论：左心室扩大的程度、二尖瓣病变的类型及手术技术是决定手术疗效的主要因素。左心室扩大指数小于１．５者成形效果较好，１．５～２．０者可成形但应控制其他危险因素的程度，２．０以上者成形手术的疗效较差，应慎重选择手术适应证。

Objective:To summarize the experience of valve reconstruction of mitral valve insufficiency with giant heart and the operative indication. Methods:Retrospective study was carried out on 33 patients of mitral valve insufficiency with giant heart undergoing valve reconstruction during Jan.1980 and Dec.1995.Among them 11 were of rheumatic,20 of congenital, 1 of degenerative and 1 of accidental injury.Fourteen of them with heart function of NYHA class I—II,while 19 of NYHA class III—IV.The mean CTR was 0 73±0 06,and the mean index of left ventricular enlargement(LVI)was 1 60±0 27. Results:There were 5 of simple annular dilatation,22 of annular dilatation with leaflet prolapsed and 6 with restricted leaflet motion and chordal fusion.The valve reconstruction included 9 of simple annuloplasty,11 of annuloplasty with a shortening plastic repair of chordae,7 with resection of prolapsed portion and suture of free edges of leaflets,1 with chordae transplantation,3 with incision of papillary muscle and 4 with suture of the fissure of the leaflets.Among them 14 of prosthetic ring annuloplasty were performed.Eight cases died in hospital(24 2%).The operative mortality was risen as LVI increased,in 1 of 9(11 1%)cases with LVI less than 1 5,5 of 21(23 8%)cases with it between 1 5—2 0 and 2 of 3(66 7%)cases with it greater than 2 0. Conclusion:The severity of heart disfunction would be a main risk factor for operative mortality.As LVI over 2 0,the indication of valve reconstruction should be carefully considered.