二尖瓣置换术后左心房重构逆转影响因素分析

Factors Determining Let Atrial Reverse Remodeling after Mitral Valve Replacement

目的观察不同心律、不同类型二尖瓣病变患者手术前、后左心房几何形态的改变,并进一步研究影响二尖瓣置换术后患者左心房重构逆转的重要因素。方法 2003年1月至2008年3月四川大学华西医院心脏大血管外科同一医疗组施行二尖瓣机械瓣置换术215例,其中男52例、女163例,年龄(40.58±10.54)岁,所用瓣膜均为St.Jude Medical机械瓣膜。按照术前二尖瓣病变类型及心律情况进行分组:二尖瓣狭窄伴窦性心律组54例,其中男13例、女41例,年龄(39.31±9.46)岁;二尖瓣狭窄伴心房颤动组56例,其中男14例、女42例,年龄(41.12±10.72)岁;二尖瓣反流伴窦性心律组52例,其中男12例、女40例,年龄(39.71±10.09)岁;二尖瓣反流伴心房颤动组53例,其中男13例、女40例,年龄(40.19±11.87)岁。所有患者二尖瓣置换术前及术后2年均行左心房几何构型的超声心动图检查。采用左心房前后径(LAD)、左心房面积(LAA)、左心房容积(LAV)、左心房容积指数(LAVi)评价左心房重构及重构的逆转情况。结果全组无住院死亡,术后发生低心排血量综合征5例,肺部感染6例,均经相应的治疗治愈出院。二尖瓣狭窄患者LAVi小于二尖瓣反流患者(P<0.05),伴窦性心律的二尖瓣病变患者其LAVi则低于伴心房颤动的二尖瓣病变患者(P<0.05);二尖瓣机械瓣置换术后2年,二尖瓣反流患者左心房重构的逆转程度高于二尖瓣狭窄患者(P<0.05),窦性心律患者左心房重构的逆转程度高于心房颤动患者(P<0.05)。结论年龄、心房颤动、术前左心房容积、二尖瓣反流、左心室舒张期末内径是影响二尖瓣置换手术患者术后左心房重构逆转的重要因素。

Objective To observe the changes of left atrial geometry before and after mitral valve replacement in patients with different types of mitral valve disease and different heart rhythm, and to identify factors determining left atrial remodeling after mitral valve replacement. Methods A total of 215 consecutive patients of mitral valve replacement in Department of Thoracic and Cardiovascular Surgery of West China Hospital, Sichuan University from January 2003 to March 2008 were selected and followed up for this study. There were 52 male and 163 female patients with their age of 40.58±10.54 years （ranged, 18-67 years）. St. Jude Medical mechanical valves were used. According to the type of mitral valve diseases （mitral stenosis （MS） or mitral regurgitation （MR）） and heart rhythm （atrial fibrillation （AF） or sinus rhythm （SR））, patients were divided into 4 groups. There were 54 patients with MS and SR （including 13 male and 41 female patients with their age of 39.31±9.46 years）, 56 patients with MS and AF （including 14 male and 42 female patients with their age of 41.12±10.72 years）, 52 patients with MR and SR （including 12 male and 40 female patients with their age of 39.71±10.09 years）, 53 patients with MR and AF （including 13 male and 40 female patients with their age of 40.19± 11.87 years）. All patients had routine examinations and echocardiogram preoperatively and two years after surgery. Left atrial anteroposterior diameter （LAD）, left atrial area （LAA）, left atrial volume （LAV） and left atrial volume index （LAVi） were used to analyze the changes of left atrial geometry. Results There was no in-hospital death. Major postoperative complications included low cardiac output syndrome in 5 patients, pneumonia in 6 patients. LAVi were lower in mitral stenosis patients than that in mitral regurgitation patients （P〈0.05）, LAVi were lower in patients with sinus rhythm than that in patients with atrial fibrillation （P〈0.05）. Two years after mitral valve replacement, the extent of left atrial reverse remodeling were significantly greater in mitral regurgitation patients than in mitral stenosis patients （P〈0.05）, and the extent of left atrial reverse remodeling were significantly greater in patients with sinus rhythm than thatmitral valve replacement.