外伤性二尖瓣关闭不全的外科治疗

Surgical treatment of traumatic mitral regurgitation

目的 探讨外伤性二尖瓣关闭不全的临床特点、外科治疗方法及其手术效果.方法 回顾分析2000年12月-2007年11月收治的16例外伤性二尖瓣关闭不全外科手术治疗的临床病例.16例中术前心胸比例0.55±0.07,左心室射血分数为（51.2±23.2）%,按纽约心脏病学会（NYHA）心功能分级：Ⅰ～Ⅱ级者10例（63%）.手术方法包括二尖瓣成形14例,二尖瓣置换术2例,并同期矫治合并病变.随访14例,随访时间（35.2±25.7）个月.结果 外伤至出现二尖瓣关闭不全症状的时间为（23.3±50.9）个月.随访时,13例二尖瓣成形者,二尖瓣血流正常4例,微量反流7例,少量反流2例.14例左心室射血分数为（66.8±9.0）%,较术前明显升高（P＜0.05）.心功能NYHA Ⅰ～Ⅱ级者13例（93%）,与术前比较,心功能NYHA Ⅰ～Ⅱ级者所占百数比明显增高（P＜0.01）.结论 外伤性二尖瓣关闭不全可在外伤后即刻出现,亦可在外伤后数年逐渐出现.选择适当的手术时机,应用综合性二尖瓣成形术或者二尖瓣置换术,多能获得满意的中远期效果.

Objective To study the clinical features of traumatic mitral regurgitation and its surgical treatment methods and outcomes. Methods Clinical data of 16 patients with traumatic mitral regurgitation surgically treated from December 2000 to November 2008 were retrospectively analyzed. The cardiac thoracic ratio was 0.55 ±0.07 and the left ventricular ejection fraction （LVEF） was （51.2% ±23.2）%. According to the New York Heart Association （NYHA） functional classification, 10 patients were at grade Ⅰ - Ⅱ before operation. The surgical procedures consisted of mitral valvuloplasty in 14 patients and mitral replacement in two, when correction of other cardiac injuries was made at the same time.Of all, 14 patients obtained follow-up for （35.2 ± 25.7 ） months. Results The interval between trauma and appearance of mitral regurgitation was （23.3 ±50.90） months. Of 13 patients with echocardiography during follow-up, there were four patients with normal tricuspid hemodynamics, seven with trace tricuspid regurgitation and two with mild regurgitation. The value of LVEF was （66.8 ± 9.0）% at followup, significantly higher than preoperation （P 〈 0. 05 ）. There were 13 patients at grade Ⅰ - Ⅱ of NYHA,with a significant increase compared with preoperation （ P 〈 0. 01 ）. Conclusions Mitral regurgitation may emerge either immediately or several years after trauma. Traumatic mitral regurgitation patients can get satisfactory outcomes when comprehensive mitral valvuloplasty or mitral replacement is performed promptly.