二尖瓣直视成形术46例远期疗效分析

Direct vision mitral valve reconstruction:a long-term follow-up of 46 cases

目的提高二尖瓣直视成形手术的远期治疗效果。方法对１９８３～１９９５年的４６例直视二尖瓣成形术病例的一般资料、手术方法、远期随访结果进行分析，并与同期二尖瓣置换术（ＭＶＲ）进行比较。结果围手术期死亡率为６％（同期ＭＶＲ死亡率为１０％）。术后心功能较术前改善Ⅰ～Ⅱ级者占９５３％（４１／４３）。术后随访２～１０年，８９２％（３３／３７）的患者临床症状有持久改善，血流动力学指标也有明显好转。成形术较换瓣术病例手术死亡率低，远期并发症少。结论熟知二尖瓣解剖，选择适当病例。

Objective To improve the longterm results of direct vision mitral valve reconstruction. Method From July 1983 throug July 1995,46 patients with mitral valve disease were treated by a direct vision reconstructive techniques.Rheumatic valve stenosis and incompetence were noted in 39 (patients),nonrheumatic insufficiencies in 5, and congenital disease in 2. According to leaflet pliability, type Ⅰ normal leaflet motion was notedin 17 patients, type Ⅱ leaftet prolapse in 3 and type Ⅲ restricted leaflet motion in 29. Cardiac function (NYHA classification) showed class Ⅱ in 2, class in 25 Ⅲ, and class Ⅳ in 19. Valvuloplasty and annuloplasty were performed with various techniques according to the pathanatomical changes of the valve. Prosthetic obturators self made were employed in 29 patients. Result The operative mortality rate was 6% (3/46). In the mitral valve replacement group it was 10% (27/265). Two to 10 years (mean 65 months) followup showed grade Ⅰ cardiac function in 6 patients, grade Ⅱ in 17, grade Ⅲ in 8,and grade Ⅳ in 3. Conclusion Good longterm results canbe achieved by valve reconstruction with lower mortality and incidence of thromboembolism than. 