二尖瓣成形术在二尖瓣关闭不全中的应用

Application of mitral valvuloplasty in mitral insufficiency

目的总结分析二尖瓣成形术患者的手术方法和临床疗效。方法回顾性分析2006年1月至2013年6月行二尖瓣成形术患者42例，手术在体外循环中低温下施行，采用瓣叶裂缺修补8例、瓣叶矩形切除缝合12例、腱索折叠或转移成形2例、后瓣瓣环环缩并交界折叠成形7例、瓣叶穿孔修补4例，缘对缘技术双孔法成形7例，单纯行人工瓣环成形2例，以上成形方法同时应用人工瓣环成形28例。术中应用注水试验和经食管超声检查（TEE），术后超声检查评估成形效果。结果全组无死亡病例，术后超声检查无反流27例（64．29％），轻度反流12例（28．57％），轻一中度反流3例（7．14％），术后因血红蛋白尿再次手术换瓣1例，再次手术率（2．38％）。随访时间1～6（3．5±1．6）年。患者均恢复日常生活及工作，心功能（NYHA）Ⅰ级32例，Ⅱ级10例。结论对于瓣叶质量较好的二尖瓣关闭不全的患者，术中根据患者二尖瓣的形态，采用相应的手术成形方式，可取得良好临床效果。

Objective To summarize and analyze the operation method and clinical effect of the mitral valvuloplas- ty. Methods The clinical data of 42 patients with mitral valvuloplasty from Jan. 2006 to Jun. 2013 were retrospectively analyzed. The operations were performed under low temperature during cardiopulmonary bypass. And among these , 8 cases adopted repairment of the cleft of the mitral leaflet, lobes rectangular resection and suture in 12 cases, chordate tendineae folded or transfer molding in 2 cases, valve annulus of the back lobe ring contraction and placation of the commeasure in 7 cases. Mitral valvuloplasty mitral valve perforation and repairmen in 4 cases. ＂Edge-to-Edge＂ technique for method of double holes in 7 cases, prosthetic ring for mitral annuloplasty in 2 cases. The above method of forming at the same time the application of artificial valve ring annuloplasty in 28 cases, during the operation, to adopt water injection test and TraM esophageal echocardiography, after the operation, to ultrasound assessment of the forming effect. Results There was no death case, and after the operation, through ultrasonography showed no tricuspid regurgitation was in 27 cases （64.29%）, mild reflux in 12 cases（28.57% ） , slight to middle degree in 3 cases（7.14% ）, and after the operalion,due to hemoglo- binuria to have another operation in 1 case, the rate of re-resection was 2.38%. The mean follow- up time was 1 - 6 （3.5 ±1.6） years. All the patients return to normal life and work, Ⅰ degree of NYHA in 32 cases, Ⅱ degree in 10 cases. Conclusions For the patients with mitral insufficiency with high quality leaflets, during the operation, according to the patient＇ s mitral morphology, to adopt corresponding operation forming and have good clinical results.