部分可曲性人工二尖瓣瓣环成形技术的临床应用

The Partial Application of Complete Flexible Artifical Ring in Mitral Valve Repair

目的总结部分可曲性人工二尖瓣瓣环成形技术治疗二尖瓣关闭不全疾病的临床应用经验,探讨其治疗效果。方法回顾性分析我院1998年1月～2006年8月施行部分可曲性人工瓣环二尖瓣成形术治疗259例二尖瓣疾病患者的临床资料,二尖瓣疾病的病理分类为风湿性二尖瓣狭窄或关闭不全16例,二尖瓣感染性心内膜炎16例,缺血性二尖瓣关闭不全13例,先天性二尖瓣关闭不全40例,退行性二尖瓣关闭不全174例。围术期采用超声心动图监测左心房(LA)、左心室舒张期末内径(LVEDD)、左心室收缩期末内径(LVESD)、左心室射血分数(LVEF)和左心室短轴缩短分数(LVFS)等指标;观察并记录围手术期和随访中生存率、二尖瓣反流率、二次手术率。结果259例患者主动脉阻断时间为74±30min,体外循环时间为105±37min。术后围术期生存率为96.5%(250/259),无脑、肝、肾等重要器官并发症发生率为93.4%(242/259),无左室流出道梗阻、冠状动脉狭窄发生。术后随访45±28个月,随访60个月时的生存率为93.8%(243/259);无二次手术率为96.1%(249/259)。术后LVEDD由术前的62.60±10.19mm缩小至52.88±8.67mm,LVEF由术前的57.91%增加为61.00%,均较术前明显改善(P<0.05)。随访中无或微量反流188例(72.6%),轻度反流62例(23.9%),中度反流8例(3.1%),重度反流1例(0.4%),二尖瓣反流程度较术前得到明显改善(P<0.05)。结论这种部分可曲性人工二尖瓣瓣环成形技术操作简单,临床效果良好。

Objective To summarize the experience and results of mitral annuloplasty with modified partial flexible artificial ring. Metbods Two hundred and fifteen-nine patients were underwent partial flexible ring annuloplasty after mitral valve plasty surgery in our hospital from Jan. 1998 to Aug. 2006. The etiology included rheumatic （16 cases）, infective endocarditis of mitral （16 cases）, ischemic （13 cases）, congenital （40 cases） and degeneration （174 cases）. Echocardiogram test were performed in the peri-operative periods to monitor the lefe atrium （LA）, left ventricular end-diastolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD）, left ventricular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS） and mitral regurgitation grades. The peri-operative mortality, morbidity, re-operation rate were recorded during the follow-up. Results Aortic cross clamping time was 74±30 min and cardiopulmonary bypass time was 105± 37min. The peri-operative survival rate was 96.5% （250/259） and free from complications rate was 93.4% （242/259）. No left ventricular out flow tract obstruction and coronary artery stenosis were occurred in this group. The 60 months survival rate was 93.8% （243/259） and 5 years non-reoperation rate was 96.1% （249/259）. The peri-operative echocardiogram results showed the LVEDD decreased from 62.60±10.19mm to 52.88±8.67mm and the LVEF increased from 57.91% to 61. 00% （ P〈0. 05）. During the follow-up the mitral regurgitation grades were improved significantly （P〈0. 05）, there were 188 cases of trifle mitral regurgitation （72.6 %）, 62 cases of mild mitral regurgitation （23.9 % ）, 8 cases of moderate mitral regurgitation （3.1%） and 1 case of serious mitral regurgitation （0. 4%）. Conclusion This simplified mitral annuloplasty technique is an easy handling and effective treatment for the mitral repair.