二尖瓣腱索断裂292例临床分析  

Clinical and echocardiographic characteristics of mitral chordal rupture from 292 hospitalized patients

作　　者：罗晓亮[1] 乔树宾[1] 袁建松[1] 关婷[1] 陈珏[1] 陈纪林[1] 宋来风[1] 高润霖[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心血管病研究所心内科冠心病诊治中心,100037

出　　处：《中华心血管病杂志》2009年第3期253-256,共4页Chinese Journal of Cardiology

摘　　要：目的探讨二尖瓣腱索断裂的临床特征、发病规律及其治疗方法。方法对292例二尖瓣腱索断裂住院患者的临床资料及病理检查结果进行回顾性分析。结果前叶腱索断裂99例（33．9％），后叶腱索断裂180例（61．6％），前后叶腱索均断裂13例（4．5％）。腱索部分断裂266例（91．1％），完全断裂26例（8．9％）。214例（73．3％）为特发性腱索断裂，78例（26．7％）为继发性腱索断裂（P〈0．05）。特发性腱索断裂多为黏液样变性所致，发病年龄较大，多为男性，且以后叶居多；继发性二尖瓣腱索断裂的病因多为感染性心内膜炎、冠心病、先天性心脏病、风湿性心脏病，发病年龄较小，多为男性，且以前叶居多。结论二尖瓣腱索断裂后叶发病率高于前叶，前后叶腱索均断裂较少见。特发性二尖瓣腱索断裂较继发性腱索断裂多见。Objective To analyze the clinical, echocardiographic features and therapy efficacy of patients with ruptured mitral cbordae tendineae. Methods Clinical data, echocardiographic and pathological results from 292 hospitalized patients with ruptured mitral chordae tendineae were retrospectively analyzed. Results There were 99 cases （33.9%） with rupture of anterior leaflet and 180 cases （61.6%） with rupture of posterior leaflet, 13 cases （4. 5% ） with both anterior and posterior leaflet ruptures. Partial rupture of mitral chordae tendineae was found in 266 cases （91.1%） and total rupture in 26 cases （8. 9% ）. Two hundred and fourteen cases （73.3%） were primary chordal rupture and 78 （26.7%） were secondary chordal rupture （ P 〈 0.05 ）. Primary chordal rupture was mostly due to mucus degeneration of the mitral valve, mostly presented as posterior leaflet rupture in aged male patients. Secondary chordal rupture was mostly caused by infective endocarditis, coronary heart disease, congenital heart disease and rheumatic heart diseases. Patients with secondary chordal rupture cases were significantly younger than patients with primary chordal rupture and there were significantly more anterior leaflet rupture than posterior leaflet rupture. One hundred and thirty patients received mitral valve reconstruction operation and another 110 underwent mitral valve replacement therapy and discharged complication free. The remaining 52 cases received medication therapy and discharged with improved symptoms （12 with mild chordal rupture without operation indication, 17 cases contraindicated to operative therapy, 7 cases transferred to other hospitals and 16 patients refused operation therapy）. Conclusions The incidence of posterior leaflet rupture is higher than that of anterior leaflet rupture. Rupture of both anterior and posterior leaflet is rare and there are more primary chordal ruptures than secondary chordal ruptures based on our patient cohort. Mitral valve reconstruction operation and mitra

关 键 词：二尖瓣闭锁不全 腱索 临床分析 治疗方法 

分 类 号：R686[医药卫生—骨科学]