缺血性二尖瓣返流的外科治疗(附38例临床报告)

Surgical treatment of ischemic mitral regurgitation (an analysis of 38 cases)

目的 介绍外科治疗缺血性二尖瓣返流的手术方法和临床结果。方法 自 1996年 12月至 2 0 0 1年 4月 ,38例缺血性二尖瓣返流患者接受了手术治疗 ,其中男性 33例 ,女性 5例 ,年龄 32～70岁 ,平均 (5 8± 8)岁。术前纽约心脏学会 (NYHA)心功能分级Ⅰ～Ⅱ级 4例 ,Ⅲ～Ⅳ级 34例。轻度二尖瓣返流 6例 ,中度 16例 ,重度 16例。合并室壁瘤 6例。除 6例轻度返流患者只行冠状动脉旁路移植术外 ,其余 32例患者均行冠状动脉旁路移植术加二尖瓣手术。结果 无手术及术后早期死亡 ,无术后早期严重并发症。所有患者均症状消失 ,痊愈出院。出院时心功能均为Ⅰ～Ⅱ级。随访 37例 ,平均随访 (2 0 8± 14 3)个月 ,除 1例远期死亡 ,1例NYHA分级心功能Ⅲ级外 ,心功能均为Ⅰ～Ⅱ级。结论 中度以上的缺血性二尖瓣返流应积极采用手术治疗的方法 ,二尖瓣成形术应为首选 ,术后效果良好。

Objective To report the surgical technique and clinical results of ischemic mitral regurgitation. Methods From December 1996 to April 2001, 38 patients with ischemic mitral regurgitation underwent surgical treatment. There were 33 males ,5 females with a mean age of (58±8) years old. The New York Heart Association (NYHA) cardiac function was class I-II 4 cases and class III-IV 34 cases. Six cases was mild mitral regurgitation, 16 moderate and 16 severe. Thirty-two patients were treated with coronary artery bypass grafting(CABG) and concomitant mitral valve correction. Six patients were treated with CABG alone because the mitral regurgitation was mild. Results No operative and postoperative death, postoperative severe morbidities happened. All patients were clinically asymptomatic, and the cardiac function was NYHA class Ⅰ-Ⅱ. Thirty-seven patients were followed up for a mean duration of (20.8±14.3) months, one case died lately and one patient was NYHA class III, the others cardiac function was NYHA class Ⅰ-Ⅱ. Conclusion Mitral valve surgery is indicated in patients undergoing coronary artery bypass graft surgery who have moderate or severe ischemic mitral regurgitation. The mitral valvuloplasty should be the first choice, and the early outcome is satisfied.