二尖瓣成形术121例回顾

Clinical experience in mitral valve reconstruction

目的:评价二尖瓣成形术的早、中期效果。方法:回顾性分析1993年9月至1999年1月二尖瓣成形术121例,其中二尖瓣脱垂69例,风湿性心脏病35例,原发性感染性心内膜炎8例,先天性二尖瓣关闭不全7例(5.9%),其他2例。均在体外循环下行二尖瓣综合成形术。手术前、后应用彩色多普勒超声心动图观察二尖瓣返流的情况。结果:术中改行二尖瓣置换术8例;术后早期死亡3例(2.65%);随访4个月至4.7年,心功能(NYHA标准)恢复级61例,级19例,级6例,级2例;心尖部闻及收缩期杂音13例,再次行二尖瓣置换术3例;晚期死亡2例;术后3年超声心动图检查二尖瓣返流量少于1.0ml者占83.6%。结论:二尖瓣脱垂因腱索断裂或延长所致者,成形术的成功率较高;风心病患者年轻、瓣膜病变较轻者,成形效果较好;老年、病史较长以及瓣膜钙化严重者,成形术的远期效果较差。

Objective: To evaluate the outcome of mitral valve reconstruction in the early and mid period. Methods: One hundred and twenty one patients with mitral valve reconstruction from September 1993 to January 1999, including 69 cases of mitral prolapse, 35 of rheumatic mitral valve disease, 8 of native valve endocarditis, 7 of congenital and 2 of other etiology, were analyzed retrospectively. All patients underwent mitral valve repair with Carpentier's technique under standard cardiopulmonary bypass. Mitral valve regurgitation were evaluated with the color Doppler echocardiography before and after operation. Results: Eight patients were transformed to mitral valve replacement during the operation. There were 3 early postoperative deaths with a mortality of 2.65%. Follow up, ranged from 4 months to 4.7 years, revealed 61 patients were in NYHA class Ⅰ, 19 in Class Ⅱ, 6 in class Ⅲ and 2 in cases Ⅳ. Mitral systolic murmur was documented in 13 cases with reoperative valve replacement performed in 3 patients. Three year postoperative echocardiographic evaluation showed that the rate of mitral regurgitation less than 1.0 ml was 83.6%. Conclusion: Mitral valve reconstruction can be performed in most patients with mitral insufficiency from mitral prolaps with chordal rupture or elongation. Young patients with moderate valvular lesion of rheumatic process seems to have a satisfied clinical outcome whereas mid term results have been less satisfactory in older patients with extensive rheumatic disease, especially severe calcification.