复杂性二尖瓣反流的外科修复  

Surreal repair of complex mitral valve regurgitation with the comprehensive application of multiple techniques

作　　者：朱丹[1] 陈安清[1] 夏利民[1] 王哲[1] 赵强[1] 

机构地区：[1]复旦大学附属中山医院心外科上海市心血管病研究所,上海200032

出　　处：《中华胸心血管外科杂志》2008年第2期76-79,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评价多技术综合运用治疗复杂性二尖瓣反流的近、中期疗效。方法2000年1月至2006年7月，34例综合应用多技术治疗多区域复杂性二尖瓣反流者，男24例，女10例。年龄23。65岁，平均（42．8±11．7）岁。其中退行性变29例，外伤（包括可疑病史）2例，马方综合征2例，缺血性1例。术前超声提示二尖瓣反流中度11例（32．4％），重度23例（67．6％）。术前心功能（NYHA）分级：Ⅱ级9例（26．5％），Ⅲ级16例（47．1％），Ⅳ级9例（26．5％），平均（3．00±0．74）级。比较其术前、术后心功能、左心室、左心房直径和二尖瓣反流程度的变化。结果无住院死亡，无手术并发症。随访1—54个月，平均（31．2±19．4）个月。随访期无死亡，无并发症，无再次手术者。术后左心房直径从术前（53．23±7．69）mm减至（38．25±6．32）mm（P〈0．05），左心室舒张末径从术前（63．74±9．64）mm减小至（48．76±7．56）mm（P〈0．05），左心室收缩末径从术前（49．39±7．14）mm减小至（35．49±6．21）mm（P〈0．05）。术后心功能较术前明显改善，平均降至（1．62±0．78）级（P〈0．05）。射血分数（EF）术前0．55±0．11，术后0．57±0．10，无明显提高（P〉0．05）。二尖瓣反流程度术后明显减轻，术中食管超声0．91±0．90，随访期间1．18±0．99（P〈0．05）。结论合理综合应用多技术可以有效治疗复杂性多区域二尖瓣反流，中期疗效满意。Objective To evaluate the clinical application and midterm result of mitral valve repair with multiple techniques for patients with complex mitral valve regurgitation. Methods From January, 2000 to July, 2006, 34 patients with complex mitral regurgitation, including 24 males and 10 females, aged 23 - 65 years [average （42.8 ±11.7） years], comprised the study group. The data of the cardiac function （NYHA/EF）, the diameter of left ventricular, left atria and the degree of mitral regurgitation were analyzed before and after operation. Results There was no mortality or major morbidity or reoperation. Patients were followed up from 1 to 54 months [average （31.2 ± 19.4） months]. The degree of mitral valve regurgitation decreased significantly after operation. The mean degree of pre-operation mitral regurgitation was 3.62 ± 0.49, and follow-up degree was 1.18 ± 0.99 （ P 〈 0.05） respectively. The diameters of left ventricular and left atria reduced. The postoperative cardiac function iraproved apparently. EF increased from 0. 55 ± 0.11 preoperatively to 0.57 ± 0.10 postoperatively （ P = 0.06）. Conclusion The comprehensive application of multiple techniques in repairing complex mitral valve regurgitation may be effective, and with a satisfying midterm results.

关 键 词：二尖瓣闭锁不全 心脏瓣膜假体植入 心脏外科手术 

分 类 号：R686[医药卫生—骨科学]