二尖瓣置换术后巨大左室的几何形态学变化及其与左室收缩功能的关系

Left ventricular geometry and systolic performance after mitral valve replacement in patients with giant left ventricle

目的 动态观察二尖瓣置换术后巨大左室的几何形态学变化 ,探讨其与左室收缩功能变化的关系。方法 回顾性分析 1991年 1月至 2 0 0 0年 12月间 2 7例巨大左室病人施行二尖瓣置换术后的超声心动图随访资料。结果 二尖瓣重度关闭不全引起的巨大左室主要以离心性扩大为主 ,换瓣术后左心室显著呈进行性缩小 ,至术后 2年心肌肥厚基本逆转 ,但左心室形态多半仍未能缩小至正常范围。术后 6个月左室射血分数和短轴内径缩短率的变化主要与术中保留瓣下结构和术前左室后壁厚度呈正相关 ,与左室收缩末直径 (LVDs)或容积 (ESV)呈负相关 (P <0 0 1)。结论 对于二尖瓣关闭不全合并巨大左室者 ,争取尽早手术 (LVDs≤ 6 0cm或ESV≤ 15 0ml前 )以及术中保留瓣下结构 ,有利于术后左心室形态的逆转和左心收缩功能的恢复。

Objective: To observe the dynamic change of left ventricular geometry and its relationship with left ventricular systolic performance after mitral valve replacement (MVR) in patients with giant left ventricle (GLV). Methods: The echocardiographic follow up date of 27 patients with GLV undergoing MVR between Jan.1991 and Dec.2000 were analyzed retrospectively. Results: The dilation of GLV caused by severe chronic mitral regurgitation was eccentrically and reduced progressively and significantly after MVR. Up to 2 years after MVR, the myocardial hypertrophy of GLV was nearly reversed, however, the geometry of GLV in more than 50% cases could not restore to normal ranges completely. The changes of left ventricular ejection fraction and fraction shortening at 6 month after MVR correlated positively with preoperative left ventricular posterior wall thickness and intra operative preservation of mitral subvalvular apparatus, and negatively with end systolic dimension (LVDs) or end systolic volume (ESV). Conclusion: Early operation (especially before LVDs≤6 0 cm or ESV≤150 ml), and preservation of subvalvular apparatus during MVR are in favor of left ventricular geometry reversal and systolic function improvement for patients with GLV due to severe chronic mitral regurgitation.