人工腱索在二尖瓣关闭不全后叶成形术中的应用及近中期疗效

Application of artificial chordae tendineae in posterior valvoplasty for mitral regurgitation and short-and medium-term therapeutic effect

目的了解人工腱索在二尖瓣关闭不全后叶病变中应用的可行性及近中期临床效果。方法选取在河北医科大学第二医院心脏外科,诊断二尖瓣脱垂伴关闭不全接受二尖瓣成形治疗的患者99例,其中单纯前叶脱垂41例,单纯后叶脱垂44例,前后叶均脱垂4例,交界脱垂10例。针对48例存在后叶脱垂的患者采用人工腱索的方法纠正二尖瓣后叶关闭不全。结果接受应用人工腱索纠正瓣膜后叶关闭不全的48例患者,随访13~81个月,平均(40.60±15.57)个月,术后1年因二尖瓣病变再次接受手术者0例,术后2年接受再次手术者共2例,术后5年接受再次手术者共2例,占全部后叶成型患者的4.2%。术后患者左心室射血分数、左心室舒张末径、二尖瓣血液返流面积以及心脏功能均较术前明显改善,差异有统计学意义(P<0.05)。随访数据显示术后6个月~1年这些指标改善更加明显。二尖瓣血液返流面积,随时间的延长,有逐渐增加的趋势,但目前资料尚未显示差异有统计学意义(P<0.05)。术后二尖瓣口血液流速、左心室流出道血液流速,以及二尖瓣瓣口面积均在正常值范围,未出现二尖瓣口狭窄。结论应用人工腱索治疗二尖瓣后叶脱垂是有效的,临床可以取得可靠的疗效。

Objective To evaluate the feasibility and short-and medium-term clinical efficacy of artificial chordae tendineae in the treatment of posterior leaflet prolapse of the mitral valve.Methods A total of 99 patients diagnosed with mitral valve prolapse and regurgitation who underwent mitral valvoplasty at the Second Hospital of Hebei Medical University were selected,including 41 patients with simple anterior leaflet prolapse,44 patients with simple posterior leaflet prolapse,4 patients with both anterior and posterior leaflet prolapse,and 10 patients with junctional prolapse.We used artificial chordae tendineae to correct mitral regurgitation in 48 patients with posterior leaflet prolapse.Results In total,48 patients who were given artificial chordae tendineae to correct posterior leaflet regurgitation were followed up for 13-81 months,with an average of(40.60±15.57)months.There was 0 patient who underwent re-operation due to mitral valve disease at 1 year after surgery,2 patients who underwent re-operation at 2 years after operation,and 2 patients who underwent re-operation at 5 years after surgery,accounting for 4.2% of all patients receiving posterior valvoplasty.Postoperatively,patients showed significant improvements in left ventricular ejection fraction,left ventricular end diastolic diameter,mitral regurgitation area,and cardiac function,as compared with preoperative levels,with statistical differences.Follow-up data showed that these indicators improved more significantly from 6 months to 1 year after surgery.The area of mitral regurgitation gradually increased with time,but currently there was no significant difference.The postoperative mitral valve orifice blood flow velocity,blood flow velocity of left ventricular outflow tract,and mitral valve orifice area were all within the normal range,and no stenosis of mitral valve was found.Conclusion Artificial chordae tendineae is effective in the treatment of posterior leaflet prolapse of the mitral valve,which can achieve favorable therapeutic results.