冠心病合并中重度缺血性二尖瓣关闭不全的外科治疗

Surgical treatment of coronary heart disease with moderate-severe ischemic mitral insufficiency

目的探讨冠心病合并中重度缺血性二尖瓣关闭不全的外科治疗原则。方法选择冠心病合并中重度缺血性二尖瓣关闭不全的手术患者61例,并对患者的临床资料进行回顾性分析。结果 45例行冠状动脉旁路移植术+二尖瓣成形术,16例行冠状动脉旁路移植术+二尖瓣置换术,其中2例患者行二尖瓣置换术,术后早期死于心力衰竭,余59例均治愈岀院。术后复查超声心动图检查显示,左心室舒张末内径从(52.8±11.3)mm降至(47.9±8.9)mm(P<0.01),LVEF从(46±11)%升至(52±12)%,差异有统计学意义(P<0.01)。结论对于冠心病合并中重度缺血性二尖瓣关闭不全的手术患者,同期处理二尖瓣后效果满意。

Objective To study the surgical treatment principles of coronary heart disease（CHD）with moderate-severe ischemic mitral insufficiency.Methods Clinical data about 61 CHD patients with moderate-severe ischemic mitral insufficiency after surgical treatment were retrospectively analyzed.Results Of the 61 patients,45underwent coronary artery bypass grafting and mitral valve repair（CABG＋MVP）and 16 received CABG＋mitral valve replacement（CABG＋ MVR）,2died of heart failure early after operation and 59 were cured and discharged.Echocardiography showed that the LVEDD was shorter after operation than before operation while the LVEF was higher after operation than before operation[（47.9±8.9）mmvs（52.8±11.3）mm,（52±12）%vs（46±11）%,P〈0.01].Conclusion Combined CABG and mitral valve procedure can achieve satisfactory outcomes in CHD patients with moderate-severe ischemic mitral insufficiency.