二尖瓣成形术367例分析

Analysis of Mitral Valvuloplasty in 367 Patients for Improving Mitral Valve Regurgitation

目的:总结367例二尖瓣成形术的临床经验,评价二尖瓣成形术的临床效果。方法:回顾性分析我院1996-10～2006-12进行二尖瓣成形术的7岁以上患者367例,其中瓣膜退行性病变295例;先天性二尖瓣病变26例;缺血性改变导致二尖瓣关闭不全20例;风湿性心脏病18例;感染性心内膜炎8例。术前纽约心功能NYHA分级Ⅱ级193例,Ⅲ级156例,Ⅳ级18例,术前超声心动图显示二尖瓣反流量轻—中度25例,中度109例,中到重度134例,重度99例;左心房内径24～71(45.10±9.13)mm,左心室舒张期末内径30～86(60.13±7.89)mm。均在低温体外循环下行二尖瓣成形术。结果:术中经打水实验或食道超声心动图评价成形效果满意,术后1周复查超声心动图示左心房内径14～83(34.99±8.30)mm,左心室舒张期末内径31～71(50.64±6.54)mm,与术前相比明显缩小,差异有统计学意义(P均<0.001)。术后早期死亡1例;331例患者随访3个月至11年,心功能NYHA分级Ⅰ级患者280例,Ⅱ级41例,Ⅲ级4例,Ⅳ级6例;超声心动图示左心房内径21～73(39.11±9.33)mm,左心室舒张期末内径34～79(50.04±6.51)mm,与术前相比明显缩小,差异有统计学意义(P均<0.001)。192例患者二尖瓣无或微量反流,97例少量反流,27例少到中量反流,7例中量反流,2例中到大量反流,6例大量反流。4例术后行二尖瓣置换术,1例发生溶血,晚期死亡4例。结论:根据二尖瓣病变的特征进行选择,采用相应的成形技术,对非风湿性二尖瓣病变行尖瓣成形术可取得较满意的临床效果。术中行食道超声心动图和注水实验能为判断手术效果提供有益的帮助。

Objective： To evaluate the clinical outcomes of mitral valvuloplasty for improving mitral valve regurgitation and heart function. Methods ： A total of 367 consecutive patients with mitral valve insufficiency whom undertaken mitral valvuloplasty from October 1996 to December 2006 in our hospital were summarized retrospectively. Before the operation, there were 295 cases of mitral degenerative prolapse or chordae rupture, 26 of congenital mitral valve disease, 20 of ischemic mitral valve insufficiency, 18 of rheumatic mitral valve disease, and 8 of infective endocarditis. Echocardiography indicated that severe mitral valve regurgitation in 99 patients, moderate to severe MR in 134, moderate in 109, and mild to moderate in 25 patients. NYHA indicated that 193 patients in class Ⅱ , 156 in class Ⅲ and 18 in class Ⅳ. All patients had the operation under standard cardiopulmonary bypass. Results ： Surgical efficacy was examined by trans-esophageal echocardiography and saline injection test during the operation. Post operative follow-up ranged from 3 months to 11 years. Echocardiography evaluation showed that after the operation non or trace amount of regurgitation in 192 cases, little amount in 97, little to moderate in 27, moderate in 7, moderate to severe in 2 and severe in 6. NYHA indicated that 280 patients in class Ⅰ , 41 in Class Ⅱ , 4 in class Ⅲ and 6 in class Ⅳ. The patients had reduced left atria dimension and reduced left ventrieular end diastolic diameter after the operation. There was 1 early post-operative death. 4 patients died during the follow up period of time. 1 patient had hemolysis and 4 had valve replacement. Conclusion ： Non-rheumatic mitral valve insufficiency patients could achieve satisfactory result with proper mitral valvuloplasty. Trans-esophageal echocardiography and saline injection test could help estimate the surgical efficacy during the operation.