二尖瓣腱索断裂的临床诊断与外科治疗

Surgical treatment of mitral valve with rupture chordae tendience (report of 52 cases)

目的 总结 5 2例二尖瓣腱索断裂的诊断和外科治疗经验。方法 全组病例均有不同程度的心功能不全。 32例行二尖瓣置换术 (MVR) ,2 0例行瓣膜修复或成形术。结果 术后 48例生存 ,4例围手术期死亡 ,病死率 7 7%。生存病例术后随访 1～ 6 7个月 ,除 1例风湿性病变者行二尖瓣、三尖瓣成形术术后 1年又出现二尖瓣中度关闭不全外 ,其余心功能均有不同程度改善。结论 风湿性病变及心内膜炎病人多以MVR为宜 ,退行性病变及先心病者应根据病理类型选择术式 ,多考虑二尖瓣成形术。

Objective To review the experience of surgical management for rupture of mitral valve chordae. Methods 52 patients with rupture of chordae tendineae of mitral valve were treated surgically. All patients had various degrees of heart failure before operation. Surgical procedures included MVR in 32 cases, MVP in 20 cases. Results 4 cases died postoperatively with a mortality rate of 7.7%. The survivors were followed-up for 1～67 months. Heart function improved. One patient with rheumatic heart disease who was treated with MVP and TVP developed mild mitral valve regurgitation one year later. Conclusion Patients with rheumatic heart disease and endocarditis should be treated likely with MVR. Patients with degenerate heart disease and congenital heart disease should be treated with MVP according to their pathology.