中重度缺血性二尖瓣反流患者行二尖瓣置换同期冠状动脉旁路移植术的临床研究

A clinical research of mitral valve replacement combined with coronary artery bypass graft surgery in patients with moderate-t o-severe ischemic mitral regurgitation

目的探讨二尖瓣置换(mitral valve replacement,MVR)同期冠状动脉旁路移植术(coronary artery bypass grafting,CABG)治疗中重度缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)的效果。方法 2010年7月—2013年1月,16例冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)合并中重度IMR的患者接受了CABG联合MVR术。其中男性8例,女性8例;平均年龄(63.4±7.6)岁。术前经胸超声心动图示中度二尖瓣反流2例,中重度8例,重度6例。比较患者术前及术后经胸超声心动图资料。结果院内死亡1例。术后复查超声心动图示二尖瓣无反流10例,轻度反流5例,轻中度反流1例。左心室舒张末内径(left ventricular end-diastolic diameter,LVEDD)从(60±13)mm下降到术后12个月随访时的(47±12)mm(P<0.05)。结论二尖瓣置换同期冠状动脉旁路移植术治疗中重度缺血性二尖瓣反流的近期效果满意,并能明显改善左心室功能。

Objective To investigate the impact of combined coronary artery bypass grafting（ CABG） and mitral valve replacement（ MVR） in patients with moderate-to-severe ischemic mitral regurgitation（ IMR）. Methods From July 2010 to January 2013,16 patients of coronary artery disease with moderate-to-severe IMR underwent mitral valve replacement combined with coronary artery bypass graft surgery. There were 8 male and 8 female patients,with a mean age of（ 63. 4 ± 7. 6） years. Preoperative transthoracic echocardiography showed moderate IMR in 2 cases,moderate to severe in 8 cases and severe in 6 cases. The data of preoperative transthoracic echocardiography were compared with postoperative ones. Results Hospital mortality was 6. 25%（ 1 case）. Postoperative transthoracic echocardiography showed that there was no regurgitation in 10 cases,minimal in 5 cases,minimal to moderate in 1 case. LVEDD decreased from（ 60 ± 13） mm to（ 47 ± 12） mm（ P〈0. 05）. Conclusions Mitral valve replacement combined with coronary artery bypass graft is a safe and effective treatment for IMR,the short-term outcomes of which are satisfactory and there is a significant improvement of left ventricular function.