二尖瓣脱垂并关闭不全的外科修补

Surgical repair of mitral valve prolapse with valve regurgitation

目的 总结二尖瓣脱垂的外科修复经验。 方法 对 44例二尖瓣脱垂患者的临床资进行回顾分析。 44例患者中风湿性 2例 ,非风湿性 42例 (2 2例合并先天性心脏病 ) ;关闭不全中度 2 4例 ,重度 2 0例 ;腱索断裂或缺如 12例 ,腱索过长 32例 ,其中多根腱索过长 6例。治疗行腱索移植 10例 ,腱索缩短 2 5例 (多根腱索缩短 6例 ) ,人工腱索 1例 ,瓣叶折叠 3例 ,瓣叶切除 5例 ;同时行瓣裂缝合 8例 ,瓣环成形 2 8例 (后环缝缩 14例 )。 结果 全组无手术死亡病例。 1例风湿性患者术后 1个月发生左心房血栓再次手术行瓣膜替换。二尖瓣功能正常 34例 (77 8% ) ,基本正常 6例 (13 6 % ) ,残留轻至中度关闭不全 3例 (6 8% )。随访 1～ 18年 (平均 6 5年 ) ,效果良好。

Objective To review the experience in surgical repair of mitral valve prolapse with valve regurgitation. [WT5”HZ]Methods[WT5”BZ] From January 1981 to June 1998,44 patients with mitral valve prolapse were treated. Among them, 2 had rheumatic valve disease, 20 mitral valve prolapse, and 22 congenital heart disease combined with mitral prolapse. All the patients had mitral valve regurgitation (moderate 24, severe 20). Chordae rupture or absence was observed in 12 patients and chordae elongation in 32. Chordae transplantation was performed in 10 patients. Elongated chordae was shortened in 25 patients and milti chordae shortened in 6. Artificial chordae was reconstructed in one patient. Concomitant procedures included mitral leaflet removal (5 patients), leaflet plication (3), closure of mitral cleft(8), and anuloplasty (28). Results There no operative mortality occurred. Follow up averaged 6 5 years (range 1 18 years). In 34 patients (77 8%), mitral function was normal. Slight and mild moderate regurgitation were noted in 6 and 3 patients respectively. In one of the patients, mitral valve replacement was done again because of left atrial embolism after operation one month. Conclusion Surgical repair of mitral valve prolapse is safe and efficacous.