人工腱索线圈治疗二尖瓣前叶脱垂  

Surgical treatment of anterior mitral valve prolapse using artificial chordal loop

作　　者：李继勇[1] 张健群[1] 张富恩[1] 何以华[1] 

机构地区：[1]首都医科大学附屈北京安贞医院心外科,100029

出　　处：《中华胸心血管外科杂志》2010年第6期365-367,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 总结采用人工腱索线圈技术治疗二尖瓣前叶脱垂的经验.方法 2008年1月至2009年8月,8例二尖瓣前叶脱垂病人中男5例,女3例;年龄28～68岁,平均（56.0±8.9）岁.心功能（NYHA）Ⅱ级2例,Ⅲ级6例.二尖瓣前叶腱索断裂7例（其中腱索断裂合并延长2例）,腱索延长1例.A1区域脱垂3例,A2 区脱垂2例,A2合并A3区脱垂3例;合并二尖瓣后叶腱索断裂2例,1例合并三房心.左室舒张末直径53～62 mm,平均（57.2±3.8）mm,射血分数（EF）0.60～0.68,平均0.63±0.02.心胸比率0.52±0.17.术中采用测量器测量腱索长度,并在测量器上制作人工腱索线圈,固定在乳头肌和瓣叶游离缘.结果 手手术死亡.1例男性病人术后第2天出现血红蛋白尿,经过碱化尿液、利尿、激素等治疗后改善.出院前复查超声心动图显示少量反流1例,微量反流7例.术后左室舒张末直径42～51 nm,平均（47.1±2.2）mm,较术前明显改善.出院后常规抗凝治疗3个月.术后随访1～19个月,平均（8.2±4.3）个月,少量反流1例,无或微量反流7例.心功能Ⅰ级6例,Ⅱ级2例,较术前明显改善.结论 人工腱索线圈治疗二尖瓣前叶脱垂近期效果确切、容易复制.Objective To summarize the clinical experience for treating anterior mitral leaflet prolapse with an artificial chordal loop. Methods From January 2008 to August 2009, pre-measured ePTFE loops were used to treat anterior leaflet prolapse in 8 patients, 5 males and 3 females, aged from 28 to 68 （ average 56.0 ± 8.9 ） years. The heart function （NYHA） was class Ⅱ in 2 patients and class Ⅲ in 6. Echocardiography showed chordal rupture in 7 patients, 2 with chordal rupture and elongation and pure chordal elongation in 1. There were 3 patients with A1 segment prolapse of anterior mitral leaflet, 2 with A2 segment prolapse, 3 with both A2 and A3 segments prolepses by Carpentier standardization. There were 2 patients with posterior leaflet chordal rupture in P2 and P3 segment, 1 with cor triatrium. Left ventricular end diastolic diameter （LVEDD） was 53 - 62 mm [average （ 57.2±3.8 ） mm]. Ejection fraction （EF） was 0.60 - 0. 68 （ average 0.63 ± 0.02）. Heart-thoracic ratio was 0. 52 ± 0. 17. We measured the normal chordal using both a caliber and by echocardiography （ for comparison after operation）. The artificial chordal loops was constructed on the caliber using ePTFE suture, and then fixed the loop to the papillary muscle and the free edge of the anterior leaflet. Results There was no operation death. Hemolysis after 2 days of operation in 1 patient was amended by alkalinization, diuresis and hormone treatment. Pre-discharge transthoracic echocardiography showed mild regurgitation in 1patient, trivial regurgitation in 7. LVEDD were 42 -51mm [average （47. 1 ±2.2） mm] significantly decreased than that of pre-operation. Following parameters were measured and compared with pre-operation： EF 0. 58 ± 0. 03 vs. 0. 63 ± 0. 02, beart function （ NYHA ） class 1.25 ± 0. 42 vs. 2.75 ± 0. 58. Normal chordal length measured by caliber was （ 21.20 ± 1.55 ） mm vs. （ 22. 10 ± 2.68 ） mm by echocardiography. Anticoagulate therapy with warfarin was for 3 months after discharge and

关 键 词：二尖瓣脱垂 腱索 心脏外科手术 线圈 测量器 

分 类 号：R686[医药卫生—骨科学]