“缘对缘”技术矫治二尖瓣关闭不全疗效分析

Analysis of outcome of edge-to-edge mitral valve repair

目的:探讨"缘对缘"技术矫治二尖瓣关闭不全的经验及近中期手术疗效。方法:2001年6月至2007年10月利用"缘对缘"技术对58例二尖瓣关闭不全患者行二尖瓣成形术,其中瓣膜退行性病变39例;先天性二尖瓣病变14例;缺血性改变导致二尖瓣关闭不全2例;感染性心内膜炎1例,风湿性心脏病2例。术前超声显示二尖瓣反流量:中度11例,中到重度21例,重度26例。结果:术中及术后早期无死亡,术后一周超声心动图示左心房内径,左心室舒张期末内径,左心室射血分数均减小。随访11个月至7年,超声心动图监测反流:无或微量20例,轻度19例,轻到中度9例,中度3例,重度2例,3例死亡,2例术后行二尖瓣置换术。结论:"缘对缘"技术是一种有效的治疗二尖瓣关闭不全的手术方法,可取得较为满意的临床效果,远期疗效需进一步观察。

Objective：To evaluate the mid-term outcome of edge-to-edge mitral valve repair for mitral regurgitation.Methods：58 consecutive patients with mitral regurgitation who underwent edge-to-edge mitral valvuloplasty from June 2001 to October 2007 were analyzed retrospectively.There were 39 cases of mitral degenerative prolapse or chordae rupture,14 cases of congenital heart disease,2 cases of ischemic mitral insufficiency,1 case of infectious valve endocarditis and 2 cases of rheumatic mitral valve disease.Preoperative echocardiography showed the degree of mitral regurgitation was severe in 26,moderate to severe in 21,moderate in 11 patients.Results：Trans-esophageal echocardiography and saline injection test were used to estimate the surgical efficacy during operation.There was no early postoperative death.Follow-up,ranged from 11 months to 7 years.Postoperative echcardiographic evaluation showed that no MR or trace in 20,and little in 19,little to moderate in 9,moderate in 3 and severe in 2.Mitral valve replacement performed in 2 patients and patients died.Conclusion：Edge-to-edge mitral valve repair is a valuable tool for treatment of mitral regurgitation and the results are satisfactory.Long-term following-up is essential.