二尖瓣成形环瓣环环缩术在缺血性二尖瓣返流中的应用

Mitral annuloplasty with prosthetic ring in ischemic mitral regurgitation

目的研究应用二尖瓣成形环行瓣环环缩术治疗缺血性二尖瓣返流的手术效果。方法选择2000年1月~2015年12月在我院行二尖瓣成形术的缺血性二尖瓣返流并发室壁瘤的患者72例,根据二尖瓣病变部位及性质选择成形方案,其中33例使用二尖瓣成形环进行瓣环环缩术。回顾性分析手术的近期、远期治疗效果。结果围手术期死亡4例(6%)。术后二尖瓣返流程度较术前明显改善,中度及中度以上二尖瓣返流1例(1%)。术后随访(5±3)年,随访期死亡11例(16%),出现中度及中度以上二尖瓣返流12例(18%)。是否使用成形环进行瓣环环缩术后早期二尖瓣返流程度无统计学差异,但远期成形环环缩组较对照组二尖瓣返流程度有显著改善(P<0.05)。结论缺血性二尖瓣返流并发室壁瘤的患者中,二尖瓣成形术可安全、有效地重建二尖瓣功能。使用成形环进行瓣环环缩可改善远期效果。

AIM The investigation studied the investigate the outcomes of mitral annuloplasty with prosthetic rings in patients with ischemic mitral regurgitation （IMR） and ventricular aneurysm. METI-IODS Seventy- two patients with IMR and ventricular aneurysm who underwent mitral valve repair and ventricular aneurysm restoration were enrolled and 33 of them underwent mitral annuloplasty with prosthetic rings. The surgical and long-term outcomes of the patients were analyzed. RESULTS Surgical mortality was 6% and mitral regurgitation was significantly corrected after surgery. During follow-up, moderate or above moderate mitral regurgitation was observed in 18% of the patients. Although the use of mitral annuloplasty ring led to prolonged cardiopulmonary bypass time and cross-clamp time, it alleviated the long-term mitral valve regurgitation. CONCLUSION In patients with IMR and ventricular aneurysm, mitral valve repair is feasible and safe in reconstructing mitral valve function. The use of mitral annuloplasty ring could potentially alleviate long-term mitral valve regurgitation.