二尖瓣综合成形术治疗风湿性二尖瓣病变的近期效果分析

Short-term prognosis of comprehensive mitral valve apparatus reconstruction for rheumatic mitral valve disease

目的分析二尖瓣综合成形术(COMVAR)治疗风湿性二尖瓣病变的近期效果。方法选取2016年9月至2017年7月在郑州大学第二附属医院接受COMVAR的6例风湿性二尖瓣病变患者为研究对象,术后对患者进行短期随访。比较手术前后左心房收缩末期直径(LAESD)、左心室舒张末期内径(LVEDD)、射血分数(EF)、二尖瓣瓣口舒张期流速以及二尖瓣口最大开口面积的变化情况,分析其预后效果。结果术后对患者进行随访,随访时间为1~11个月,平均(5.8±2.4)个月。术前心功能(NYHA分级)Ⅱ级5例、Ⅲ级1例,术后NYHA分级全部恢复为Ⅰ级。患者术后LAESD、LVEDD、EF和二尖瓣瓣口舒张期流速与术前相比,差异无统计学意义(P>0.05)。患者术后二尖瓣口最大开口面积为(2.3±0.68)cm2,大于术前的(1.2±0.35)cm2,差异有统计学意义(P<0.05)。结论 COMVAR治疗风湿性二尖瓣病变的近期预后效果良好。

Objective To observe the short-term prognosis of comprehensive mitral valve apparatus reconstruction for rheumatic mitral valve disease. Methods Six patients with rheumatic mitral valve disease were selected from September of 2016 to July of 2017 in the Second Affiliated Hospital of Zhengzhou University. The changes of left atrial end-systolic dimension（ LAESD）,left ventricular end-diastolic dimension（ LVEDD）,ejection fractions（ EF）,the rate of blood flow in the opening of the mitral valve and the maximum opening area of mitral valve were compared between before and after operation. Results The patients were followed up for 1 to 11 months after surgery,with an average of（ 5. 8 ± 2. 4） months. There were 5 cases with cardiac function（ NYHA classification） in lever Ⅱ,1 cases in level Ⅲ before operation,and the patients were fully recovered for levelⅠafter operation. There were significant differences in LAESD,LVEDD,EF and the rate of blood flow in the opening of the mitral valve between before and after operation（ P 0. 05）. The maximum opening area of mitral valve was significantly greater after operation than before operation,and the difference was statistically significant（ P 0. 05）. Conclusion The short-term prognosis of comprehensive mitral valve apparatus reconstruction fo rheumatic mitral valve disease is satisfactory.