心内膜心肌纤维化的诊断和治疗  

Diagnosis and surgical treatment of endomyocardial fibrosis

作　　者：王水云[1] 吴信[1] 杨秀滨[1] 朱晓东[1] 胡盛寿[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院外科成人中心,北京市100037

出　　处：《中国心血管病研究》2006年第7期495-497,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的总结5例心内膜心肌纤维化的诊断和治疗经验。方法自1991年11月至2005年11月收治5例心内膜心肌纤维化患者,男性3例,女性2例,年龄7～58岁。其中右室型4例,左室型1例。5例均进行超声心动图检查,心室造影和心导管测压4例,MRI和同位素检查各1例。3例进行了手术治疗,切除纤维化心内膜,同时包括三尖瓣替换、二尖瓣替换和三尖瓣成形术各1例。结果入院时5例经超声心动图检查,确诊1例,3例单纯诊断为房室瓣反流,1例误诊为三尖瓣下移畸形。心室造影4例,确诊2例,2例单纯诊断为房室瓣反流。MRI检查1例,即确诊。2例术中确诊。3例手术患者中,2例右室型患者分别随访14年、3个月,前者心功能Ⅱ级,后者Ⅰ级。1例左室型患者术后2年半死于二尖瓣位机械瓣瓣周漏导致的心衰。结论心内膜心肌纤维化单独超声心动图检查容易误诊、漏诊。结合MRI有助于明确诊断。凡有严重房室瓣反流或明显心功能不全的患者,宜行手术治疗,包括房室瓣成形或替换及纤维内膜切除。Objective To review the experience of diagnosis and surgical treatment of endomyocardial fibrosis in 5 patients. Methods Five patients （three men and two women, aged 7-58 years） were diagnosised with endomyocardial fibrosis at Fu Wai Hospital from 1991 to 2005. Four had right ventricular and the other one had left ventricle infected. Three of the 5 patients had surgical resection. Tricuspid valve replacement, mitral valve replacement and tricuspid valve reconstruction was performed in 1 case, respectively. Results Correct diagnosis before operation was made in 1/5 of cases by echocardiography, in 2/4 by angiography, and in 1/1 by magnetic resonance imaging （MRI） examination, respectively. Diagnosis of myocardial fibrosis was made during the operation in 2 cases. There was no operative death. Two patients with right ventricular impaired had cardiac function improved from NYHA Ⅳ to NYHA Ⅱ in 1 patient after 14 years follow-up, the other one improved from NYHA Ⅲ to NYHA Ⅰ after the follow-up of 3 months. One patient with left ventricle disease died of heart failure caused by mechanical valvular leakage at 2.5 years postoperatively .Conclusion Endomyocardial fibrosis is very rare in the north China. Preoperative correct diagnosis can be made by careful examination of echocardiography and MRI. Resection of endomyocardial fibrosis and atrial-ventricular valves replacement or reconstruction are indicated in the setting of severe atrial-ventricular valve insufficiency and heart failure.

关 键 词：心内膜心肌纤维化症 二尖瓣闭锁不全 三尖瓣闭锁不全 

分 类 号：R542.23[医药卫生—心血管疾病]