成人再次二尖瓣成形术的临床特征分析

Analysis of Clinical Characteristics of Redo Mitral Repair in Adults

目的分析二尖瓣成形术后复发性病变的病因,总结再次二尖瓣成形术的手术技术和效果。方法回顾分析2012年1月至2019年10月阜外医院19例行再次二尖瓣成形术的成人患者的临床资料,男12例,女7例,首次手术年龄4~66岁,平均(34.9±22.6)岁。先天性二尖瓣关闭不全7例,退行性二尖瓣关闭不全12例。再次手术时年龄18~81岁,平均(43.5±19.1)岁。两次手术间隔2~430个月,平均(118±116)个月。再次手术同期进行三尖瓣成形术5例,冠状动脉搭桥手术2例,左房血栓清除1例。术前心胸比0.56±0.07,左房内径(LA)为(49.4±8.5)mm,左室舒张末径(LV)为(56.6±5.9)mm,左室射血分数(LVEF)62.6%±7.8%。结果手术失败组包括瓣叶缝线撕脱5例,瓣叶裂未完全缝合2例、人工瓣环瓣周漏2例、人工腱索撕脱1例。病变进展或新发病变组包括新发瓣叶脱垂4例,瓣环明显扩张2例,自体腱索断裂1例,感染性心内膜炎1例,二尖瓣相对性狭窄1例。本组患者体外循环时间(109±53)min,阻断时间(70±29)min,术后呼吸机使用时间(16±5.8)h。围术期无死亡。出院时有2例二尖瓣少中量反流,LA为(42.9±6.1)mm,LV为(53.4±6.3)mm,LVEF为59.3%±3.8%。术后随访(21.0±14.9)个月。1例术后2个月出现感染性心内膜炎,二尖瓣中量反流。另有1例术后10个月发生脑梗死。无死亡、再次手术患者,心功能均为Ⅰ级或Ⅱ级。结论二尖瓣成形术后出现复发性二尖瓣病变患者,在瓣叶条件良好,反流原因明确情况下,行再次二尖瓣成形手术可以获得满意的围术期结果,近中期疗效良好。

Objective To analyze the etiology of recurrent mitral lesions after mitral valve repair,and to summarize the surgical techniques and effects of redo mitral valve repair.Methods Clinical data of 19 adult patients who underwent re-mitral valvuloplasty at Fuwai Hospital from January 2012 to October 2019 were retrospectively analyzed.Twelve males and seven females had an average age of(34.9±22.6)years(range,4-66 years),7 cases of congenital mitral regurgitation and 12 cases of degenerative mitral regurgitation.The average age at the time of the redo operation was(43.5±19.1)years(range,18-81 years),and the average interval between the two operations was(118±116)months(range,2-430 months).Five patients underwent tricuspid valvuloplasty,two underwent coronary artery bypass graft surgery,and one underwent left atrial thrombectomy.Preoperative cardiac-thoracic ratio was 0.56±0.07,left atrial inner diameter(LA)was(49.4±8.5)mm,left ventricular end diastolic diameter(LV)was(56.6±5.9)mm,and left ventricular ejection fraction(LVEF)was 62.6%±7.8%.Results The technical failure group included 5 cases of leaflet suture dehiscence,2 cases of leaflet cleft incomplete suture,2 cases of ring dehiscence,and 1 case of artificial chordae rupture.The disease progression or new-onset group included 4 cases of new prolapse of valve leaflets,2 cases of significantly enlarged annulus,1 case of autogenous chordae rupture,1 case of infective endocarditis,and 1 case of relative mitral stenosis.The extracorporeal circulation time of all the patients was(109±53)min,the arrest time was(70±29)min,and postoperative ventilator time was(16±5.8)h.No perioperative death occurred.There were 2 cases of mild to moderate mitral regurgitation at discharge,LA was(42.9±6.1)mm,LV was(53.4±6.3)mm,and LVEF was 59.3%±3.8%.The follow-up time was(21.0±14.9)months.One case had infective endocarditis,with moderate regurgitation,and one had cerebral infarction during follow-up.There was no death or reoperation.Cardiac functions of all patients were gradeⅠorⅡ.Conclusion In patients with recurrent mitral valve disease after mitral valve repair,with good leaflet conditions and clear reason for the lesions,a satisfactory perioperative and follow-up result can be obtained by performing redo mitral valve repair.