二尖瓣前叶脱垂个性化成形67例临床分析

Personalized Strategies of Mitral Valve Repair for Anterior Leaflet Prolapse in 67 Patients

目的分析二尖瓣成形术矫治二尖瓣前叶脱垂的近、远期疗效，总结其临床经验。方法2002年1至2013年6月北京安贞医院心脏外科应用“缘对缘”成形、人工腱索、腱索缩短、“缘对缘”腱索转移法等各种成形击治疗二尖瓣前叶脱垂共67例，其中男41例、女26例，年龄18～71（46．34±7．68）岁，体重43～91（65．30±18．60）．术前心功能分级（NYHA）Ⅱ级5例，Ⅲ级27例，Ⅳ级35例。腱索断裂46例，腱索延长21例。二尖瓣反流面（15．36±4．53）cm^2，术前左心室射血分数29％～71％。所有患者出院前、术后6个月及以后每1～2年再次行超声心动图检查，以观察二尖瓣成形术矫治二尖瓣前叶脱垂的近、远期疗效。结果 围术期无死亡。除1例患者术后第3d出现瓣膜穿孔，1例术后6个月因成形环撕脱导致血红蛋白尿，再次行心瓣膜成形术外，其余患者均无需二次手术。随访67例，随访率100％，随访时间2～138（65．6±17.3）个月。随访期间无死亡，术后心功能分级（NYHA）全部恢复至Ⅰ级。术后复查超声心动图二尖瓣瓣口面积2_3～4：8（3．63±0．79）cm^2，均无明显反流，反移积（O．574±0．37）cm^2，术后左心房内径[（38．23±11．56）mm vs．（49．26±10．36）mm，P〈0．05]、左心室舒张期末p[（43．35±13．74）mm vs．（64．29±12．54）mm，P〈0．05]较术前明显缩小。结论几乎所有二尖瓣前叶脱垂患{可以通过个性化二尖瓣成形手术治疗获得良好的手术效果。

Objective To analyze short- and long-term results of mitral valve repair for the treatment for mitral anterior leaflet prolapse （ALP）, and summarize our clinical experience. Methods Clinical data of 67 patients with mitral ALP who underwent mitral valve repair in Department of Cardiac Surgery of Beijing Anzhen Hospital from January 2002 to June 2013 were retrospectively analyzed. There were 41 male and 26 female patients with their age of 18-71 （46.34±7.68 ） years and body weight of 43-91 （65.30 ±18.60） kg. Preoperatively, there were 5 patients in New York Heart Association （NYHA） function class II, 27 patients in class III, and 35 patients in class IV . Surgical techniques included ＇edge-to- edge＇ technique, artificial chordal replacement, chordal shortening and edge-to-edge chordal transformation. There were 46 patients with chordal rupture and 21 patients with chordal elongation. Mean mitral regurgitation （MR） area was 15.36±4.53 cm2, and left ventricular ejection fraction （LVEF）was 29%-71%. Echocardiography was performed before discharge, 6 months and every 1 to 2 years after the operation for all the patients to observe short- and long-term results of mitral valve repair for the treatment for mitral ALP. Results There was no in-hospital death. One patient underwent mitral valve replacement because of anterior leaflet perforation 3 days after the operation. Another patient underwent a second mitral valve repair because of avulsion of mitral annulus and proteinuria 6 months after the first operation. None of the other patients received reoperation. All the 67 patients （100%） were followed up for 2-138 （65.6±17.3 ） months. During follow-up, there was not late death, and all the patients were in NYHA functional class I. Echocardiography showed that cross-sec- tional area of the mitral valve was 2.3-4.8 （3.63 ±0.79）cm% There was no significant MR, and mean MR area was 0.57_0.37 crn2. Left atrium diameter （38.23±11.56 mm vs. 49.264±10.36 ram, P 〈 0.05） and left ventricular end-diastolic diameter （43.354±13.74 mm vs. 64.29±12.54 mm, P 〈 0.05） were significantly smaller than preoperative values. Conclusion Nearly all the patients with mitral ALP can receive personalized mitral valve repair with satisfactory surgical outcomes.