3D成形环置入对二尖瓣环直径的影响

The impact of three-dimension ring on size of mitral annulus

目的:观察3D成形环置入后,瓣环内径的变化趋势。方法:2014年10月至2014年11月,连续23名患者在我科室进行瓣膜成形。其中二尖瓣成形23例,三尖瓣成形13例。分别在术前、术后1周、术后3个月、采用经胸超声测量二尖瓣环和三尖瓣环的前后径和左右径,观察手术前后二尖瓣环及三尖瓣环内径的变化。结果:23例患者中男性16例,平均年龄(48.9±12.3)岁。退行性病变17例,风湿性病变5例,感染性病变1例。23例患者中二尖瓣狭窄合并二尖瓣关闭不全和三尖瓣关闭不全3例,二尖瓣狭窄合并二尖瓣关闭不全1例,二尖瓣关闭不全合并三尖瓣关闭不全10例。共置入二尖瓣成形环23枚(Edwards Physio II,30~34mm),三尖瓣成形环13枚(Edwards MC3,30~34mm)。与术前相比,术后1周二尖瓣前后径(P<0.001)、左右径(P<0.001)、三尖瓣左右径均明显变小(P<0.001)。与术后1周相比,术后3个月二尖瓣前后径有扩大趋势,但差异无统计学意义(P=1.0),二尖瓣左右径明显扩大(P=0.002),三尖瓣左右径有轻微扩大(P=0.041)。但与术前相比,术后3个月二尖瓣前后径(P=0.005)、左右径(P=0.022)、三尖瓣左右径均显著缩小(P=0.043)。相对于术后1周,术后3个月二尖瓣前后径、左右径、三尖瓣左右径扩大的比例分别为(11.7±6)%、(14.7±4)%、(12.6±3)%。结论:瓣膜成形环置入后能明显缩小病变瓣环的尺寸,与术后1周相比术后三个月瓣环有轻度扩张,但扩张程度不超过15%。成形环置入有助于维持瓣环的稳定,避免瓣环的扩张。

Objective： To investigate the change of mitral annulus after implantation of 3 D annuloplasty ring. Methods： Between October 2014 and November 2014,consecutive 23 patients underwent mitral valve repair in our department,mitral valve repair for 23 patients and tricuspid valve repair for 13 patients. Transthoracic echocardiography were performed to measure diameter of mitral annulus and tricuspid annlus before operation,1 week and 3 months after operation. Results： Sixteen patients were male. The mean age was（ 48. 9 ±12. 3） years. There were 17 patients for degenerative change,5 patients for rheumatic heart disease and 1 for infective endocarditis. Twenty mitral annuloplasty ring and 13 tricuspid annuloplasty ring were implanted. Compare to pro-opertion,anteroposterior diameter（ P〈0. 001） and left-right diameter（ P〈0. 001） of mitral annulus and left-right diameter of tricuspid（ P〈0. 001） at 1 week after surgery were significantly decreased. Compare to1 week after surgery,anteroposterior diameter had a trend to enlarge,but not reach statistical significance,however,left-right diameter of mitral annulus（ P = 0. 002） and tricuspid annulus（ P = 0. 041） increased. However,compared with pro-operation,anteroposterior diameter（ P = 0. 005） and left-right diamiter（ P = 0. 022） of mitral annulus significanly decrease. And left-right diameter of tricuspid were significantly decreased（ P =0. 043）. with respect to 1 week after surgery,anteroposterior diameter and left-right diamiter of mitral annulus,left-right diamiter of tricuspid annulus enlarged（ 11. 7 ± 6） % 、（ 14. 7 ± 4） % 、（ 12. 6 ± 3） %,respctively.Conclusion： Implantation of annuloplasty ring help to reduce the size of annulus. Compare to 1 week after surgery,mitral annuus enlarged less than 15%. Annuloplasty ring help to preserve stablity of annulus,and prevent enlarge of annulus.