二尖瓣成形与生物瓣置换术后左心结构及功能对比研究

Comparative Study of Plastic Surgery for Mitral Valve and Biogenic Valve Replacement on Left Ventricular Structure and Function

目的探讨二尖瓣成形术与生物瓣置换术对左心结构及功能预后的差异。方法选择台湾振兴医院因二尖瓣反流行二尖瓣成形或生物瓣置换术的患者50例,其中二尖瓣成形组(成形组)18例,生物瓣置换组(置换组)32例。手术前后均行经胸超声心动图检查,常规测量主动脉根部内径(AO)、左心房前后径(LA)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF),评估二尖瓣反流情况,并比较手术前后各参数变化的组间差异。结果术后两组LA和LVEDD均有缩小,成形组较生物瓣置换组缩小程度更为明显(P<0.05)。术后早期(1个月内),成形组LVESD缩小,置换组则略有扩大,两组有统计学差异(P<0.05);成形组的LVEF在术后早期升高,置换组降低,差异有统计学意义(P<0.05)。成形组术后出现二尖瓣中度反流1例(5.56%),轻度反流9例(50.00%),无明显反流或微量反流8例(44.44%),置换组无中度及以上反流0例(0),轻度反流8例(25.00%),无明显反流或微量反流24例(75.00%),两组差异无统计学意义(P=0.062)。结论左心室结构恢复和术后早期心功能改善的效果,二尖瓣成形优于生物瓣置换,但二尖瓣反流纠治的彻底性生物瓣置换似乎略优于成形。

Objective To compare the different effect of the plastic surgery for mitral valve and biological valve replacement on left ventricular structure and function. Methods Totally 50 patients with mitral valve regurgitation admitted to Taiwan Zhenxing Hospital were selected,18 patients underwent plastic surgery for mitral valve（ Plastic group） and 32 patients underwent biological valve replacement（ replacement group）. Thoracic echocardiography before and after the operation were executed. The aortic root diameter（ AO）,left atrial diameter（ LA）,left ventricular end-diastolic diameter（ LVEDD）,left ventricular end-systolic diameter（ LVESD） and left ventricular ejection fraction（ LVEF）（ simpson method was adopted） were measured, and the quantity of mitral valve regurgitation was assessed. The differences of the changes before and after surgery between the two groups were compared. Results After operation,the LA and LVEDD of the two groups were reduced,and the reduction degree of the plastic group was more obvious than that of the replacement group（ P〈0. 05）. In early post-operation（ in the 1st month）,the LVESD became smaller in the plastic group,while it was expanded slightly in the replacement group,the difference between the two groups was significant（ P〈0. 05）. Meanwhile,the LVEF in the plastic group increased in the early post-operation but reduced in the replacement group, the difference between the two groups was significant（ P〈0. 05）. In the follow-up, 1 case of moderate regurgitation（ 5. 56%）, 9 cases of mild regurgitation（ 50. 00%） and 8cases of no obvious regurgitation（ 44. 44%） were showed in the plastic group,while no moderate or severe regurgitation（ 0）,8 cases of mild regurgitation（ 25. 00%） and 24 cases of no obvious regurgitation（ 75. 00%） in replacement group,the difference between the two groups was not significant（ P = 0. 062）. Conclusion Plastic surgery for mitral valve is better in the reversion of left ventricular structure and the early improvement of left ventricular function than the biological valve replacement. As for radical treatment for mitral regurgitation,the biological valve replacement seems to be slightly better than the plastic surgery for mitral valve.