应用人工腱索行二尖瓣成形术治疗原发性感染性心内膜炎患者的中远期疗效

The mid-long term results of application research of artificial Gore-Tex chordate in mitral valvuloplasty in patients with infective endocarditis

目的评估应用人工腱索行二尖瓣成形术治疗原发性感染性心内膜炎二尖瓣反流患者的中远期疗效。方法回顾性分析我院2012年1月至2015年12月28例原发性感染性心内膜炎二尖瓣关闭不全患者行二尖瓣成形术的临床资料,男17例、女11例,年龄18~69(52.0±15.4)岁。19例为中度关闭不全,9例为重度关闭不全;术前心功能(NYHA)Ⅱ级6例,Ⅲ级14例,Ⅳ级8例;急性期手术2例,亚急性期及慢性期手术26例。同期行冠状动脉旁路移植术1例,主动脉瓣置换术6例,主动脉瓣成形术5例,三尖瓣成形术20例,心房颤动射频消融术5例。结果所有患者术后均予以随访,随访时间6~55(30.5±6.4)个月。术后心功能均明显改善。术后随访左心大小较术前进行性显著减小,左心房内径由术前的(51.78±17.50)mm降低至术后的(36.64±8.50)mm(P<0.05),左心室舒张期末内径由术前的(57.70±7.49)mm降低至术后的(49.30±5.05)mm(P<0.05);左心室射血分数值进行性显著提升,由术前的53.86%±8.16%提高到术后的59.14%±4.23%(P<0.05),无明显反流16例,轻度反流8例,轻-中度反流2例,中度反流1例,复发心内膜炎1例,再次手术1例。无死亡,无瓣膜反流加重。无血栓形成、栓塞等相关并发症的发生。结论应用人工腱索行二尖瓣成形术治疗原发性感染性二尖瓣关闭不全,手术效果安全、可靠,中远期疗效满意,值得推广应用。

Objective To evaluate the mid-long term results of application research of artificial Gore-Tex chordate in mitral valvuloplasty in patients with mitral insufficiency caused by endocarditis. Methods We retrospectively analyzed the clinical data of 28 consecutive infective endocarditis（IE） patients who received mitral valve repair with Gore- Tex in our hospital between January 2012 and December 2015. There were 17 males and 11 females. The age of these patients ranged from 18 to 69 （52.0±15.4） years. Echocardiography before operation showed the degree of mitral regurgitation （MR） was severe in 19 patients, moderate in 9 patients. Six patients were in New York Heart Association （NYHA） class Ⅱ, 14 in class Ⅲ, 8 in class Ⅳ. There were 26 selective surgeries and 2 emergent surgeries. One patient had concomitant coronary artery bypass graft. Six patients had aortic valve replacement. Five patients had aortic valve repair. Twenty patients had tricuspid valve repair. Five patients had Maze procedure. Results Follow-up was done to all the patients for 6 months to 55 （30.5±6.4） months. During the follow-up, the echocardiography showed that postoperative left atrium diameter （36.64±8.50 mm vs. 51.78±17.50 mm, P〈0.05） and left ventricular end-diastolic dimension （49.30±5.05 mm vs. 57.70±7.49 mm, P〈0.05） were significantly smaller than those before operation. The left ventricular ejection fraction （EF） increased from 53.86%±8.16% to 59.14%±4.23% （P〈0.05）. No MR was found in 16 patients, mild MR in 8 patients, mild to moderate MR in 2 patients, moderate MR in 1 patient. One patient required reoperation for recurrent infection. No death or complications related to thrombosis and embolism occurred after operation.Conclusion Application research of artificial Gore-Tex chordate in mitral valve repair is feasible for treating mitral valve lesions caused by endocarditis, and may provide a long-term outcome to the patients.