二尖瓣反流合并主动脉根部瘤的二尖瓣成形策略

Treatment of mitral valve repair to patients with mitral valve regurgitation combined with aortic root aneurysm

目的:回顾两种二尖瓣成形术治疗合并主动脉根部瘤的二尖瓣反流,探讨此手术的临床效果。方法:2010年7月至2015年5月,北京安贞医院收治的33例合并主动脉根部瘤的二尖瓣反流的患者进行回顾性分析,男性28例,女性5例,平均年龄(53.2±15.5)岁。其中25例患者置入二尖瓣成形环(成形环植入组),所置入的二尖瓣人工瓣环平均直径为(29.5±1.5)mm,8例患者行交界环缩术(交界环缩组)。术前超声心动图显示:所有患者二尖瓣病变均为中度或重度关闭不全,成形环植入组反流面积为(8.5±4.1)cm2,交界环缩组反流面积为(5.7±1.3)cm2。成形环植入组患者平均体外循环时间(164.2±29.3)min,平均主动脉阻断时间(118.2±23.4)min,交界环缩组患者平均体外循环时间(111.9±28.4)min,平均主动脉阻断时间(77.8±22.2)min。结果:术后无死亡,无恶性心律失常及其他严重并发症。成形环植入组术后平均ICU停留时间为(23.0±12.5)h,交界环缩组术后平均ICU停留时间为(23.0±8.8)h。复查超声心动图显示:成形环植入组少量反流8例,无或微量反流17例;交界环缩组少量反流4例,无或微量反流4例。结论:二尖瓣反流合并主动脉根部瘤时可以经房间隔切口或房间沟切口行成形环植入术和经主动脉切口行交界环缩术。上述两种二尖瓣成形术治疗主动脉根部瘤合并二尖瓣反流的效果确切,对于二尖瓣反流程度较轻的患者可以采用经主动脉切口行交界环缩术,以减少体外循环和阻断的时间。

Objective： To evaluate the patients with mitral valve regurgitation combined with aortic root aneurysm corrected with mitral valve repair. Methods： From July 2010 to May 2015,33 patients with mitral valve regurgitation combined with aortic root aneurysm underwent MVP in Anzhen Hospital. There were 28 males and 5 females,the average age was（ 53. 2 ± 15. 5）. Palsty rings were implanted in 25 cases with the mean diameter（ 29. 5 ± 1. 5） mm（ Group R）,and Kay annuloplasty was performed in 8 cases（ Group K）. The preoperative UCG showed all the patients were moderate or severe mitral regurgitation,regurgitation area ofGroup R was（ 8. 5 ± 4. 1） cm2,and regurgitation area of Group K was（ 5. 7 ± 1. 3） cm2. In the Group R,the mean cardiopulmonary bypass（ CBP） time was（ 164. 2 ± 29. 3） minutes,mean aortic clamped time was（ 118. 2 ± 23. 4） minutes. In the Group K,the mean CBP time was（ 111. 9 ± 28. 4） minutes,mean aortic clamped time was（ 77. 8 ± 22. 2） minutes. Results： No perioperative death and serious complications occurred in these patients. In the Group R,the mean ICU stay was（ 23. 0 ± 12. 5） hours. In the Group K,the mean ICU stay was（ 23. 0 ± 8. 8） hours. Postoperative echocardiography demonstrated： In the Group R,mild mitral regurgitation（ MR） was in 8 patients,and trace or no MR was in 17 patients. In the Group K,mild MR was in4 patients,and trace or no MR was in 4 patients. Conclusion： MVP to the patients with aortic root aneurysm combined with mitral valve disease can be implanted palsty rings via the atrial septal incision or the atrial ditch,or performed Kay annuloplasty via the aortic incision. Both outcomes of the two methods above was satisfactory.For patients with more mild regurgitaion,Kay annuloplasty via the aortic incision can be used to reduce the CPB time and the aortic clamped time.