二尖瓣成形术多技术复合应用治疗复杂性二尖瓣关闭不全的效果

Efficacy of Multiple Mitral Valvuloplasty Proceduresin Complicated Mitral Insufficiency

目的探讨二尖瓣成形术(MVP)多技术复合应用治疗复杂性二尖瓣关闭不全(MI)的临床效果。方法对23例复杂性MI患者按常规在全身麻醉中度低温体外循环下手术,综合应用多项MVP技术进行二尖瓣修复,包括瓣矩形切除、前叶三角形切除、腱索缩短、腱索转移、缘对缘二孔化、置入人工腱索、置入人工瓣环等,术中采用注水实验和经食管超声心动图检查评估成形效果。结果全组病例围术期无死亡,平均体外循环时间(114±4)min,平均主动脉阻断时间(69±21)min。术后1周心脏彩超复查:二尖瓣无任何反流或微量反流18例,轻度反流5例。出院时心功能均明显改善,其中NYHAⅠ级14例,Ⅱ级9例。随访中1例缺血性病变患者术后9个月二尖瓣由微量反流增加至中度反流,其余患者恢复良好,无异常出血、血栓栓塞、心内膜炎等重大并发症发生。结论对复杂性MI患者,根据二尖瓣病因与病变部位,合理选择MVP多技术复合应用治疗,可获得良好的临床疗效。

Objective To investigate the clinical efficacy of multiple mitral valvuloplasty （MVP）procedures incomplicatedmitral insufficiency（MI）.Methods Twenty-three patients with MI underwent moderate hypothermic cardiopulmonary bypass surgery under general anesthesia. Multiple MVPprocedures were used for mitral valve repair,including rectangular resection of the valve,triangular resection of anterior lobe,chordal shortening,chordal transfer,artificial chordae implantation,edge-to-edge repair,artificial chordae implantation,artificial valve ring implantation, etc.During operation,water injection test and transesophageal echocardiography were performed to assess the efficacy.Results No patients died in the perioperative period.The average cardiop-ulmonary bypass time and aortic crossclamp time were（114±4）minutes and（69±21）minutes, respectively.At 1 week after operation,echocardiography showed that 18 patients had no or slightmitral regurgitation and 5 patients had mild mitral regurgitation.At discharge from hospi-tal,14 patients were in NYHA I and 9 patients were in NYHA II.During follow-up,the degree of mitral regurgitation increased from slight to moderate in 1 patient,and good recovery was a-chieved and no abnormal bleeding,thromboembolism,endocarditis and other complications were＆amp;nbsp;found in the other 22 patients.Conclusion Multiple MVP procedures should be rationally used according to the pathogenesis and lesion location to achieve a good clinical efficacy in patients with complicatedMI.