综合性二尖瓣修复技术在风湿性二尖瓣病变中的应用(附16例报告)

Application of comprehensive mitral valve repair technique in rheumatic mitral valve disease

目的总结风湿性二尖瓣病变患者行二尖瓣修复手术的临床经验,分析其手术适应证及早期疗效。方法回顾性分析2014年9月至2018年9月福建省立医院心外科同一组医生采用二尖瓣成形术治疗16例风湿性二尖瓣病变患者的临床资料,其中男3例,女13例;年龄36~68(47.8±9.1)岁;单纯狭窄者7例,狭窄合并关闭不全9例,合并持续性心房颤动6例,左房血栓4例,三尖瓣关闭不全3例;术前心功能Ⅲ级11例,Ⅱ级5例。根据二尖瓣瓣膜病变类型选择不同修复方法。术后对患者进行随访,比较手术前后左心室舒张末期内径(LVEDD)、左心房收缩末期直径(LAESD)、射血分数(EF)、二尖瓣口最大开口面积的变化、二尖瓣跨瓣压差、二尖瓣反流、心功能变化情况。结果术后NYHA分级全部恢复为Ⅰ级。术后LAESD、LVEDD、EF和术前相比,差异均无统计学意义(P>0.05)。术后二尖瓣口最大开口面积为(2.21±0.43)cm2,二尖瓣跨瓣压差(8.93±2.30)mm Hg,与术前比较,差异均有统计学意义(P<0.05)。术后二尖瓣反流轻微11例,轻度反流4例,轻中度反流1例。6例房颤射频消融术后,4例维持窦性心律,1例房颤复发,1例于术后3年因高度传导阻滞行永久起搏器安置术。结论对于早、中期病理改变的风湿性二尖瓣病变,综合性二尖瓣修复技术可以取得早期的良好疗效。

Objective To summarize the clinical experience of mitral valve repair in patients with rheumatic mitral valve disease,and to analyze its surgical indications and early curative effect.Methods The clinical data of 16 patients with rheumatic mitral valve disease treated with mitral valvuloplasty by the same group of doctors in Fujian Provincial Hospital from September 2014 to September 2018 were analyzed retrospectively,including 3 males and 13 females.The age was 36-68(47.8±9.1)years.There were 6 cases of persistent atrial fibrillation,4 cases of left atrial thrombus,3 cases of tricuspid insufficiency,11 cases of preoperative cardiac functionⅢand 5 cases of preoperative cardiac functionⅡ.Different repair methods were selected according to the type of mitral valvular disease.The patients were followed up after operation.The changes of left ventricular end-diastolic diameter(LVEDD),left atrial end-systolic diameter(LAESD),ejection fraction(EF),mitral valve orifice maximum opening area,mitral valve transvalvular pressure difference,mitral regurgitation and cardiac function before and after operation were compared.Results All the NYHA grades recovered to gradeⅠafter operation.There was no significant difference in LAESD,LVEDD and EF between preoperation and postoperation(P>0.05).The maximum opening area of mitral valve orifice was(2.21±0.43)cm2,and the mitral valve transvalvular pressure difference was(8.93±2.30)mm Hg after operation,and the differences were statistically significant(P<0.05).There were 11 cases of mild mitral regurgitation,4 cases of mild regurgitation and 1 case of mild to moderate mitral regurgitation.After radiofrequency ablation of atrial fibrillation,sinus rhythm was maintained in four cases,atrial fibrillation recurred in one case,and permanent pacemaker placement was performed in one case due to high conduction block three years after operation.Conclusion For rheumatic mitral valve disease with early or middle pathological changes,comprehensive mitral valve repair technique can achieve early and good results.