二尖瓣粘液退行性变的诊断和外科治疗

DIAGNOSIS AND SURGICAL TREATMENT OF MYXOMATOUS OF MITRAL VALVE

目的 :研究二尖瓣粘液退行性变的诊断、病理改变和治疗方法。方法 :二尖瓣粘液退行性变患者 36例 ,均在中度低温体外循环下进行手术。 2 8例行二尖瓣置换术 ,其中 1例保留全部二尖瓣叶及其瓣下结构 ,4例保留部分前叶和全部后叶及其瓣下结构 ,2 0例保留部分后叶及其瓣下结构。 8例行二尖瓣成形术 ,其中 4例行Carpentier’s环成形术 ,2例行DeVega成形术 ,2例行腱索乳头肌缩短 +瓣叶折叠。 结果 :围术期因严重低心排死亡 1例。随访 5～ 84个月 ,1例因抗凝过量致脑出血死亡。其余 34例中 ,心功能Ⅰ级2 1例 ,心功能Ⅱ级 12例 ,心功能Ⅲ级 1例。二尖瓣成形 8例中 ,3～ 6个月复查心脏超声多普勒 ,2例无返流 ,5例轻度返流 ,1例重度返流 ,二尖瓣瓣口面积均在 2 .5cm2 以上。结论 :本病确诊依靠术中所见及病理结果 ,结合病史、心脏超声检查。二尖瓣置换术是目前本病最为有效的治疗方法 ,保留瓣下结构对术后左室功能的恢复极为重要。二尖瓣成形是目前最理想的治疗方法 。

Objective:To review the diagnosis,pathological changes and surgical experience in the treatment of myxomatous degeneration of mitral valve (MDMV).Methods:36 cases of MDMV were treated with operations carried out with the aid of cardiopulmonary bypass.Of the 28 patients having undergone mitral valve replacement (MVR), mitral leaflet and the chordae tendineae were preserved in 25(1 case of whole leaflet and chordae tendineae preservation,4 cases of partial anterior leaflet and whole posterior leaflet and chordae tendiineae preservation,and 20 partial posterior leaflet and chordae tendineae.)8 patients received mitral annuloplasty(Carpentiers annuloplasty ring was used in 4, De Vega’s procedure in 2,chordal shorting in 2).Results:One patient died of severe low cardiac output.Postoperative followup lasted 5～84 months.One death resulted from cerebral haemorrage.In 34 survivors,postoperative heart function were markedly improved (NYHA class I in 21,class Ⅱ in 12,class Ⅲ in 1).In mitral annuloplasty group echocardiography revealed that 5 had mild mitral valve regurgitation 1 had moderate to severe regurgitation,and mitral valve orifice area as measured to be over 2.5 cm2 in every case.Conclusion:MVR is the first choice for MDMV at present.Preservation of the mitral leaflet and chordae tendinae has a beneficial effect on postoperative left ventricular function.The most desirable result can be obtained through proper annuloplasty.