人工腱索加二尖瓣成形环治疗非风湿性二尖瓣关闭不全  

Treatment of Non-Rheumatic Mitral Regurgitation With Artificial Chord and Mitral Annuloplasty Ring

作　　者：徐方杰[1] 周睿[1] 陈佩莉[1] 张卫[1] 李颖则[1] 陈石[1] 叶伟[1] 石伟[1] 任书南[1] 吴卫华[1] 

机构地区：[1]上海市胸科医院心外科,200030

出　　处：《中国循环杂志》2008年第3期211-213,共3页Chinese Circulation Journal

摘　　要：目的:评估二尖瓣修补治疗非风湿性二尖瓣反流患者的效果。方法:1997-06至2007-06,本组为301例非风湿性二尖瓣关闭不全的患者施行了二尖瓣成形手术,其中162人为男性,139人为女性,117人为中度关闭不全,184人为重度关闭不全。平均年龄为(53.2±16.4)岁(15～72岁)。术前NYHA心功能Ⅱ级55例,Ⅲ级187例,Ⅳ级59例。99例前瓣脱垂(腱索断裂64例,腱索延长35例),后瓣脱垂139例(腱索断裂88例,腱索延长51例),前、后瓣都脱垂63例。患者中7例合并冠心病,1例合并主动脉瓣关闭不全,12例合并三尖瓣关闭不全,11例合并房间隔缺损(继发孔型)。手术均使用可膨胀聚四氟乙烯缝线替换腱索(4CVGore-Tex缝线)。所有患者都有不同程度的二尖瓣环扩张,都常规使用二尖瓣瓣环成形环施行瓣环成形。所有手术都在全麻、中度低温(28℃～31℃)及体外循环下进行。平均主动脉阻断时间为(76.2±12.3)min。结果:1例术后早期死于多脏器功能衰竭,1例患者术后因重度二尖瓣反流导致溶血而施行了机械瓣置换。除死亡和换瓣者以外,所有患者术后都予以随访(2个月～10年)。除1例外,其余的患者术后心功能都得到明显的改善(275例NYHAⅠ,23例NYHAⅡ,3例NYHAⅢ)。282例无或有轻微二尖瓣反流,17例轻度反流,2例中度反流。左心室舒张末期容积(LVEDV):术前为(157.8±49.1)ml,术后为(109.3±29.3)ml(P<0.001)。结论:以二尖瓣成形治疗非风湿性二尖瓣关闭不全可获得良好和稳定的效果。Objective ：This study was performed to evaluate the results of mitral valve repair in patients with mitral regurgitation of non- rheumatic etiology. Methods： Between July 1997 and June 2007,301 patients, of which 162 were male and 139 female, with moderate （117 patients） to severe （184 patients） mitral regurgitation,were performed mitral valve repair in our unit. The mean age was 53.2 ± 16. 4 years （range 15-72 years）. 55 patients were in New York Heart Association class Ⅱ , 187 in class Ⅲ, and 59 in class Ⅳ. Prolapse of the anterior leaflet was presented in 99 patients （chordal rupture in 64 patients, chordal elongation in 35 ）, prolapse of the posterior leaflet in 139 （chordal rupture 88, chordal elongation 51 ） , both leaflets in 63. The concomitant diseases included coronary artery disease in 7 patients, aortic valve insufficiency in 1, tricuspid valve regurgitation in 12, secundum atrial septal defect in 11. The technique we used in the operations was replacement of chordae tendineae with expanded polytetrafluoroethylene sutures （4CV Gore-Tex）. Different extent of the dilatation of the mitral annulus was found in all patients, and annuloplasty was perfmxaed routinely with annuloplasty ring. All procedures were performed under general anesthesia, moderate hypothelxaia （28 31℃ ） and cardiopulmonary bypass. The mean cross clamp time is 76. 2 ± 12. 3 min. Results ： Early postoperatively, one patient died of multiple organ failure, one patient underwent mitral valve replacement with mechanical prosthesis for hemolysis caused by sever mitral regurgitation. All patients, except those died or being converted to mitral valve replacement, were followed postoperatively （rage 2 months to 10 years, mean followup time 4. 8 ± 1.7 years ）. Except one patient, the rest of all patients had their cardiac function improved apparently （275 patients were in New York Heart Association class Ⅰ ,23 patients in class Ⅱ ,3 patient in Ⅲ ）. There is no or trivial mitral valve

关 键 词：二尖瓣成形 二尖瓣关闭不全 人工腱索 

分 类 号：R541.2[医药卫生—心血管疾病]