二尖瓣成形术治疗二尖瓣前叶脱垂的疗效分析

Efficacy Analysis of Valvuloplasty for Anterior Leaflet Prolapse

目的总结二尖瓣成形术治疗二尖瓣前叶脱垂的经验,分析其临床效果。方法回顾性分析1997年2月至2007年3月152例二尖瓣前叶脱垂的非风湿性心脏病患者在我院行二尖瓣成形术的临床资料,男96例,女56例;年龄10～73岁(38.54±17.22岁)。其中瓣膜退行性病变119例,先天性二尖瓣病变24例,缺血性二尖瓣关闭不全3例,感染性心内膜炎6例。术前超声心动图提示:二尖瓣反流量中度70例,中度至重度63例,重度19例;前叶病变87例,前叶+后叶病变65例;152例患者均在低温体外循环下行二尖瓣成形术。结果术中经注水实验或食管超声心动图评价成形效果满意,术后早期无死亡。随访3个月～8.5年,随访135例,随访率88.82%(135/152);心功能分级(NYHA)Ⅰ级93例,Ⅱ级35例,Ⅲ级3例,Ⅳ级4例;超声心动图提示:术后左心房内径(41.09±10.40mmvs.45.32±10.07mm,t=4.186,P=0.000),左心室舒张期末内径(52.04±7.74mmvs.60.70±7.72mm,t=9.676,P=0.000)与术前比较均明显缩小;无或微量反流36例,轻度反流45例,轻度至中度反流38例,中度反流9例,中度至重度反流7例。5例术后行二尖瓣置换术,晚期死亡3例,其中2例死于心力衰竭,1例死亡原因不明。结论虽然二尖瓣前叶病变成形手术相对复杂,但根据患者的具体病变情况选用相应的成形手术方法治疗二尖瓣前叶脱垂,可取得较满意的临床效果。

Objective To summarize the experiences and analyze the efficacy of mitral valvuloplasty in treating anterior leaflet prolapse.Methods A total of 152 consecutive non-rheumatic heart disease patients including 96 males and 56 females with anterior leaflet prolapse who underwent mitral valvuloplasty from February 1997 to March 2007 were analyzed retrospectively.The age of these patients ranged from 10 to 73 years old （38.54±17.22 years）.There were 119 cases of mitral degenerative prolapse or chordae rupture,24 of congenital heart disease,3 of ischemic mitral insufficiency,and 6 of native valve endocarditis.Echocardiography before operation showed the degree of mitral regurgitation was severe in 19,moderate to severe in 63,and moderate in 70 patients.Among the patients,87 had anterior prolapse and 65 had bilateral prolapse.All patients underwent mitral valve repair under standard cardiopulmonary bypass.Results During the operation,trans-esophageal echocardiography and saline injection test showed satisfying results in all the patients.No early death occurred after operation.Follow-up was done to 135 patients for 3 months to 8.5 years with a follow-up rate of 88.82%.During the follow up,93 patients were in New Yoke Heart Association（NYHA）class Ⅰ,35 in Class Ⅱ,3 in class Ⅲ and 4 in class Ⅳ.The Echocardiography showed that postoperative left atrium diameter （41.09±10.40 mm vs.45.32±10.07 mm,t=4.186,P=0.000） and left ventricular end-diastolic dimension （52.04±7.74 mm vs.60.70±7.72 mm,t=9.676,P=0.000） were significantly smaller than that before operation.No or trace mitral regurgitation （MR） was found in 36 patients,mild MR in 45 patients,mild to moderate MR in 38 patients,moderate MR in 9 patients,and moderate to severe MR in 7 patients.Mitral valve replacement was performed in 5 patients after valvuloplasty.Three died during the follow-up.Two of them died of heart failure and one of unknown cause.Conclusion In spite of the complexity,the long-term results of mitral valve repair for anterior leaflet prolapse are satisfactory if the best surgery method is chosen.