冠心病合并二尖瓣关闭不全的手术治疗效果

Analysis of surgical treatment of coronary artery disease with mitral regurgitation

目的：分析冠心病合并中、重度二尖瓣关闭不全的患者同期行冠状动脉旁路移植术和二尖瓣手术的早期效果,总结此类患者的治疗经验。方法：2002年8月到2006年5月,42名冠心病合并中、重度二尖瓣关闭不全的患者于北京大学第一医院心外科接受冠状动脉旁路移植合并二尖瓣手术。二尖瓣关闭不全原因为：缺血性38例（90.48%,38/42）;风湿性2例（4.76%,2/42）,退行性2例（4.76%,2/42）。全组患者术前心射血分数（ejection fraction,EF）0.20～0.80（平均0.41±0.14）,行二尖瓣置换（mitral valve replacement,MVR）12例,二尖瓣成形术（mitral valvuloplasty,MVP）30例。结果：院内死亡4例（9.52%,4/42）,术后早期二尖瓣返流无到轻度36例,残余中度返流2例,均不需再次手术。全组患者心射血分数与术前相比差异无统计学意义（术前0.41±0.14,术后0.45±0.12,P=0.152）;而行MVP组EF值与术前相比改善明显（术前0.36±0.08,术后0.41±0.10,P=0.013）。结论：外科手术是治疗冠心病合并中度以上二尖瓣关闭不全的有效方法。二尖瓣的处理以成形为首选,使用二尖瓣成形环是保证手术效果的重要环节。

Objective： To analyze the effect of combined coronary artery with mitral valve surgery and summarize our clinical experience. Methods： From August, 2002 to May, 2006, 42 patients underwent combined CABG and mitral valve surgery because of concomitant ischemia myocardium disease and mitral regurgitation （MR） of moderate to severe degree. The etiology of MR was ischemic myocardium disease in 38 （90.48%, 38/42）, rheumatic heart disease in 2（4.76%, 2/42）and degenerative valve disease in 2（4.76%, 2/42）. Preoperative eject fraction （EF） was 0.20-0.80 （mean 0.41±0.14）.Of all the patients 12 cases underwent mitral valve replacement and 30 mitral valvuloplasty. Results： Affer surgery 4 （9.52%,4/42） patients died in hospital. 36 patients were discharged with trivial to mild MR and 2 with moderate MR which had been severe preoperatively. The mean EF shows no significant improvement in discharged patients （0.41±0.14 preoperative versus 0.45±0.12 postoperative, P=0.152）. But in MVP group, significant difference could be found （0.36±0.08） preoperative versus 0.41±0.10 postoperative, P=0.013）. Conclusion： Coronary artery disease and mitral valve insufficiency could be effectively corrected by combined CABG and mitral valve procedure. MVP is preferred and annuloplasty ring involvement could ensure effect of operation.