应用自体心包条行二尖瓣瓣环成形的疗效评价

Clinical application of mitral annuloplasty with autologous pericardial band

目的 总结自体心包成形条在二尖瓣成形术中的应用及临床疗效.方法 回顾性分析2011年11月至2015年9月我院采用二尖瓣成形术治疗169例二尖瓣关闭不全患者的临床资料,其中男性102例、女性67例,年龄20～79（47.5±10.5）岁;术前超声心动图发现二尖瓣中度返流（Ⅲ级）32例、重度返流（Ⅳ级）137例.手术方法为体外循环下修复二尖瓣瓣叶及瓣下结构,同时所有病例均使用心包条环缩瓣环.手术中注水试验和经食管超声心动图评价成形效果.结果 平均体外循环时间（120.6±30.3）min,主动脉阻断时间（65.6±15.5）min;围术期死亡3例,死亡原因为低心排综合征、多器官功能衰竭和败血症.术后心脏超声心动图提示：二尖瓣无返流（0级）99例,微量返流（Ⅰ级）43例,轻度返流（Ⅱ级）22例,轻至中度返流（Ⅲ级）2例.所有患者均无二尖瓣狭窄和二尖瓣收缩期前向运动（SAM）.术后随访150例（90.3％）,随访时间12～40个月.随访期间2例死亡,其中1例死因与心脏疾病无关;3例行二尖瓣置换术.随访期超声心动图显示左房直径、左室舒张末直径明显减小（P＜0.05）.NYHA心功能分级Ⅰ级119例、Ⅱ级26例.结论 二尖瓣成形术中应用自体心包条环缩成形是简单、安全、有效的,能较好地维持左心功能,早期疗效满意.

Objective To conclude the experience of mitral valve repair with autologous pericardial band and assess the clinical efficacy.Methods The clinical data of 169 patients were retrospectively reviewed,including 102 males and 67 females with mitral valve regurgitation,underwent mitral valve repair with autologous pericardial band from November 2011 to September 2015 in WuHan Aisa Heart Hospital.The age of these patients ranged from 20-79（47.5-± 10.5）years.The echocardiography showed that the preoperative degree of mitral valve regurgitation were moderate in 32 cases,severe in 137 cases.All procedures were performed under moderate hypotherrnia and cardiopulmonary bypass,mitral valve were repaired and annuloplasty were performed with autologous pericardial band.The outcome of mitral valvuloplasty was evaluated by affusion test and transesophagus echocardiography intraoperatively.Results The mean cardiopulmonary bypass and mean clamp time were （120.6±30.3）minutes and （65.6±15.7）minutes.There were 3 periopearative deaths,one patient died of low cardiac output syndrome （LCOS）,one patient died of multiple organ failure,the other died of sepsis.Before discharged hospital,the results of echocardiography showed that there is no mitral valve regurgitation in 99 patients,trivial in 43 patients,mild in 22 patients and moderate in 2 patients.No one have mitral stenosis or systolic anterior motion （SAM）.150 （90.3％）patients were followed up from 12 months to 40 months.During follow-up,2 patients were death,one died of no-cardiac cause;3 patients underwent mitral valve replacement.left atrium size （LA） and left ventricular end diastolic volume（LEVED） decreased significantly than preoperative respectively（P＜0.05）.The rest of patients had their cardiac function improved apparently （112 patients were in New York Heart Association class Ⅰ,33 patients in class Ⅱ）.Conclusion Application of autologous pericardial band in mitral valve repair is simple,safe and effective for treating mitral valve regurgitation and it could restore the left ventricular function with early good results.