自体心包材料二尖瓣环成形术的中期结果

Prospective evaluation of the mid-term results of posterior mitral annuloplasty using autologous peri.cardium for mitral valve insufficiency

目的 回顾性分析自体心包材料二尖瓣环成形术的中期效果.方法 采用自体心包材料行二尖瓣环成形术48例.Carpentier分型：Ⅰ型5例,Ⅱ型41例,Ⅲ型2例.瓣叶及瓣下结构成形包括后叶四边形切除30例,瓣叶修补7例,腱索转移4例,“缘对缘”技术2例,人工腱索3例.伴随手术包括主动脉瓣替换1例,三尖瓣成形11例,冠状动脉旁路移植术9例,冠状动脉肌桥松解1例,永久性起搏器植入1例.自体心包条的长度为（51.9 ±2.8）cm.术后随访15～96（62.2 ±21.3）个月.采用门诊随访及电话随访方式,随访内容包括临床症状、心功能、超声心动图检查等.结果 术后左心室舒张末期内径[（45.1±1.3） mm vs（58.6±1.7）mm,t=12.85,P＜0.01]、左心房内径[（38.0±1.4）mm vs （50.6±1.6） mm,t=9.58,P＜0.01]明显缩小.全组早期术后无明显反流.术后30 d内死亡1例.远期无死亡,术后发生脑梗死1例,远期出现中度反流1例.无溶血并发症,无再次手术.结论 自体心包材料二尖瓣环成形是一种抗凝并发症发生率低、耐久性可、心功能维护好、廉价的成形方法.

Objective To prospectively evaluate the mid-term results of mitral annuloplasty using autologous pericardium for mitral valve insufficiency.Methods From April 2004 to December 2011,48 patients underwent mitral annuloplasty using autologous pericardium,the average length of pericardial strips was （51.9 ±2.8）cm.Carpentier classification was class Ⅰ in 5 cases,class Ⅱ in 41 cases,and class Ⅲ in 2 cases.The mitral valve repair techniques included quadrangular resection in 30 cases,valve repair in 7 cases,chordae transposition in 4 cases,＂edge to edge＂ technique in 2cases,and artificial chordae tendineae in 3 cases.Concomitant procedures included one case arotic valve replacement,11 cases tricuspid valve repair,9 cases coronary artery bypass grafting,1 case coronary artery muscle bridge resection,and 1 case permanent pacemaker implant.Datum on long-term outcomes were obtained by questionnaires and by phone interview [average follow-up time （62.2 ± 21.3） months].Results Compared with preoperative datum,the diameters of left ventricular end diastolic diameter （LVDD） and left atrial diameter （LAD） examined by echocardiography show significant reduction in postoperative [（58.6 ± 1.7） mm vs （45.1 ± 1.3） ram,t =12.85,P 〈0.01 ; （50.6 ± 1.6）mm vs （38.0 ± 1.4）ram,t =9.58,P 〈0.01].There was early postoperative death in one case,cerebral infarction in one case,but none of patients died in late postoperative period.One patient had moderate mitral valve regurgitation in long-term follow-up.None of patients had redo operation and hemolytic complications.Conclusions Mitral annuloplasty using an autologous pericardium was an acceptable technique with low anticoagulation complications,permanent,well left ventricular function maintenance,and an economic method.