冠状动脉粥样硬化性心脏病合并中重度二尖瓣反流的外科治疗

Surgery treatment in patients with coronary heart disease complicated by moderate or severe mitral regurgitation

目的总结冠状动脉粥样硬化性心脏病(冠心病)合并中重度二尖瓣反流的外科治疗临床经验。方法回顾性分析2002年7月至2011年2月期间,外科手术治疗冠心病合并中重度二尖瓣反流患者59例的临床资料。其中合并二尖瓣中度反流46例,重度反流13例,二尖瓣的病理改变主要表现为单纯瓣环扩大、瓣叶脱垂或二尖瓣腱索断裂,手术均在全麻低温体外循环下进行。其中二尖瓣成形49例;二尖瓣置换10例。结果院内死亡3例(5.08%),50例患者随访3～72个月,二尖瓣中度反流3例,重度反流1例,余均为轻微或轻度反流,均无再次手术。结论冠心病合并中重度二尖瓣反流应积极处理,其中以二尖瓣成形为首选。

Objectives To summarize the clinical experience of surgery treatment in patients with coronary heart disease（CHD） complicated by moderate or severe mitral regurgitation（MR）.Methods Clinical data of 59 patients with CHD complicated by moderate or severe MR after hypothermic cardiopulmonary bypass（CPB） from July 2002 to February 2011 were respectively analyzed.There were 46 patients with moderate MR and 13 patients with severe MR.The predominant pathological changes of mitral valve were isolated annular dilation,valvular prolapse or chordal rupture.All patients received coronary artery bypass grafting（CABG） which included mitral valvuloplasty in 49 patients and mitral valve replacement（MVR） in 10 patients.Results Three patients died in hospital（5.08%）.Fifty patients were followed up for 3 to 72 months,of which moderate mitral regurgitation was found in 3 patients,severe regurgitation in 1 patient and minor or mild regurgitation in others.There were no re-operation patients.Conclusions HD with moderate or severe mitral regurgitation should be treated aggressively.Mitral valvuloplasty is the first choice.