Butterfly修复技术应用于二尖瓣后叶严重脱垂患者外科修复的中远期疗效分析

Middle and long-term effect of Butterfly repair technique in severe prolapse of posterior leaflet in mitral valve insufficiency

目的探讨二尖瓣Butterfly修复技术应用于二尖瓣后叶严重脱垂患者外科修复的中远期疗效。方法回顾性分析2016年7月—2019年10月南京大学医学院附属鼓楼医院34例行外科瓣膜修复的二尖瓣后叶严重脱垂患者的临床资料。其中男21例、女13例,年龄33~73岁。患者均在浅低温体外循环下完成二尖瓣Butterfly修复技术。术后随访超声心动图,评估术中、术后二尖瓣反流程度,观察有无收缩期前向运动(SAM)现象及其他并发症。结果34例患者均成功完成二尖瓣修复,手术时间143~223 min,心肌阻断45~69 min。术中经食道超声心动图提示微量反流/无反流,均无SAM现象。患者术后均获随访5~44个月,无死亡和严重心血管不良事件。末次随访经胸超声心动图显示,轻微反流/无反流33例、无症状中度反流1例,均无SAM现象。所有患者出院/术后3个月后均停用华法林抗凝治疗。结论对于二尖瓣后叶严重脱垂患者,使用二尖瓣Butterfly修复技术可以获得较好的中远期修复效果,术中最大限度降低了二尖瓣后叶高度,避免了SAM现象,且手术技术难度不大,便于推广。

Objective To evaluate the middle-and long-term effects of Butterfly repair technique in patients with severe mitral valve posterior leaflet prolapse.Methods A total of 34 patients(21 male and 13 female patients,age ranged from 33 to 73 years old)with severe prolapse of the posterior leaflet who were subjected to Butterfly technique in Nanjing Drum Tower Hospital from July 2016 to October 2019 were retrospectively analyzed.All patients were operated with mitral valve Butterfly repair under mild hypothermia cardiopulmonary bypass.Intraoperative,postoperative,and follow-up cardiac ultrasound data were collected to evaluate the degree of mitral regurgitation.Results The mitral valve was successfully repaired in all patients.The range of operation time was 143-223 min,and the aortic cross-clamping time was 45-69 min.Intraoperative esophageal ultrasound showed slight or no mitral valve reflux,and no systolic anterior motion phenomenon was found.No deaths or adverse events were recorded during follow-up from 5 to 44 months.According to the symptoms and ultrasound results during follow-up,the review of echocardiography showed slight or no reflux in 33 patients and moderate reflux with no symptom in one patient.No systolic anterior motion phenomenon was observed,and warfarin anticoagulation was terminated after 3 months.Conclusions Butterfly repair technique can be used to obtain a better shaping effect for patients with severe prolapse of the posterior leaflet of mitral valve because the height of the posterior leaves is greatly reduced to avoid SAM,which is proven to have satisfactory middle-and long-term effects.