保留二尖瓣瓣下结构对双瓣置换术后中期左心室收缩功能的影响

Influence of keeping subvalvular mitral structure on mid-term left ventricular systolic function after double valve replacement operation

目的了解及评价不同二尖瓣置换术式对双瓣置换术后患者中远期左室收缩功能变化的影响。方法回顾分析二尖瓣主动脉瓣双瓣置换术后患者,术后出院6个月以上回院复查超声心动图的199例患者的临床资料。根据术中二尖瓣瓣下结构保留程度的不同分为3组:A组20例患者为保留全部瓣下结构;B组95例保留后瓣叶瓣下结构;C组84例全部切除二尖瓣前后瓣叶下结构。平均随访时间(21.61±14.72)月。对比分析3组患者术后超声心动图检查结果。结果术后中期A组的左心室短轴缩短率高于其余两组,差异有统计学意义(P<0.01),但3组患者在左房前后径、左室前后径和左心室射血分数方面差异均无统计学意义(P>0.05)。结论双瓣置换术中,完全保留二尖瓣瓣下结构比仅保留后瓣或不保留瓣下结构更有利于中期左心室收缩功能的恢复。

Objective The aim of this study is to investigate and evaluate the influence of different replacement of mitral valve method on mid-term and late left ventricular systolic function. Methods Retrospectively analyzed the clinical data of 119 cases of patients,those who received replacement of mitral valve and aortic vaives and discharged from hospital for more than six months and came back to hospital for echocardiogram. The patients were divided into three groups according to the hold degree of mitral valve,there were 20 cases of patients in group A and the subvalvular structure was completely hold back,there were 95 cases of patients in group B and subvalvular structure of posterior lobe was hold,there were 84 cases of patients in group C and none subvalvular structure was hold. The average following time was（ 21. 61 ± 14. 72） months. The postoperative echocardiograms of the three groups were compared. Results The fractional shortening of the left ventricular minor semi axis of group A was higher than the other two groups,the differences were statistically significant（ P 0. 01）. The differences of the LADD,LVDD and LVEF among the three groups were not statistically significant（ P0.05）.Conclusions We conclude that complete subvalvular structure preservation is feasible in DVR patients and has significant mid-term recovery of left ventricular contractility advantages than posterior preservation of subvalvular structure and non-preservation of subvalvular structure.