二尖瓣成形术治疗二尖瓣后叶脱垂  

Clinical experience of mitral valvuloplasty in treating posterior leaflet prolapse

作　　者：陈宏伟[1] 郑理玲[1] 谢纳新[1] 张志孟[1] 孙学军[1] 

机构地区：[1]福建医科大学附属泉州市第一医院心血管外科,泉州市362000

出　　处：《中国心血管病研究》2012年第5期329-332,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的分析总结33例非风湿性二尖瓣后叶脱垂成形手术的效果。方法回顾性分析我院2005年5月至2011年5月行二尖瓣成形术治疗二尖瓣后叶脱垂（除外其他合并畸形、风湿性病变及前叶脱垂）患者33例，男性18例，女性15例，平均年龄46．5岁。术前二尖瓣中重度关闭不全9例、二尖瓣重度关闭不全24例。通过部分瓣叶矩形切除、瓣环环缩及成形环的综合运用修复二尖瓣，同期置入二尖瓣爱德华弹性环28枚。结果全组病例均痊愈出院，无围术期死亡。患者术前心脏彩超检查：左房内径（49．26±17．13）mm，左室内径（60．29±8．32）mm，射血分数（66．1±9．6）％，左室短轴缩短率29．78±6．81。术后1周心脏彩超检查：左房内径（40．23±7．93）mm，左室内径（50．63±4．67）mm，射血分数（53．0±8-3）％，左室短轴缩短率23．50±5．01。术后6个月复查心脏彩超检查：左房内径（36．16±7．46）mm，左室内径（45．61±5．67）mm，射血分数（65．0±7．6）％，左室短轴缩短率29．67±5．91。随诊6-70个月，平均随访18．2个月，二尖瓣功能正常或有微量反流22例，有微少量和少量反流9例，有少中量反流2例。无因二尖瓣关闭不全而再次手术者。结论对于二尖瓣后叶脱垂的病变，术中在经食管超声的帮助下，通过部分瓣叶矩形切除、瓣环环缩及成形环的综合运用，能够修复几乎所有非风湿性所导致的二尖瓣后叶脱垂，避免瓣膜置换。对于非风湿性二尖瓣后叶病变，瓣膜成形技术成熟、可靠，修复效果满意。Objective Analysis of 33 cases of posterior mitral leaflet prolapse by non-rheumatic who take for the mitral valve repair, in order to provide a reasonable basis for mitral valve repair. Methods Thirty- three patients with posterior mitral leaflet prolapse underwent mitral valve repair between May 2005 and May 2011 in the first hospital of Quanzhou, excluding patients with other malformations, rheumatic disease and prolapse of the anterior lobe）, 18 males, 15 females, mean age 46.5 years. Moderate to severe mitral insufficiency was found in 9 patients, severe mitral regurgitation in 24 patients. We cut part of the valve leaflets, contracted annular ring, and made an integrated use of Valvuloplasty ring. And 28 Edward elastic mitral rings were implanted in the sameperiod. Results All the patients were cured and no perioperative deaths. Preoperative echocardiography examina- tion ： the left atrium size （ LA ） （49.26±17.13 ）mm, left ventricular end diastolic diameter （LV） （60.29±8.32）mm, left ventrleular ejection fraction （ LVEF ） （66.1 ±9.6 ）%, left ventricular fractional shortening （ LVFS ）29.78 ±6.81. E- ehocardiogTaphy examination in the first week after surgery： the left atrium sizel （LA）（40.23±.93）mm, left ven- tricular end diastolic diameter （ LV ） （ 50.63±4.67 ）mm, left ventricular ejection fraction （ LVEF ） （ 53.0 ± 8.3 ） %, left ventricular fractional shortening rate （LVFS）23.50±5.01. Echocardiography examination 6 months later： the left atrium size（LA）（36.16±7.46）mm, left ventricular end diastolic diameter（LV）（45.61±5.67）mm, left ventrieu- lar ejection fraction（LVEF）（65.0±7.6）%, left ventricular short axis shortening（LVFS）：29.67±5.91. Post- opera- tive follow-up time was 6-70 months, average was 18.2 months. Mitral valve function was normal or traces regur- gitation in 22 eases, micro-small and small amount of regurgitation in 9 patients, and a small amount of reflux in 2 cases. No one underwent re-op

关 键 词：二尖瓣后叶脱垂 二尖瓣关闭不全 二尖瓣成形术 

分 类 号：R654.2[医药卫生—外科学]