功能性二尖瓣反流在主动脉瓣置换术后的转归及预测因素分析  

Outcome and predictive factor analysis of functional mitral regurgitation after aortic valve replacement in patients with severe aortic insufficiency

作　　者：孙勇新[1] 丁文军[1] 洪涛[1] 陈昊[1] 夏利民[1] 赵东[1] 王春生[1] 

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

出　　处：《中华胸心血管外科杂志》2012年第9期526-529,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结重度主动脉瓣关闭不全（aorticinsufficiency，AI）合并左心室扩大及功能低下患者伴随的功能性二尖瓣反流（functionalmitralregurgitation，FMR）在主动脉瓣置换术（aorticvalvere—placement，AVR）后的转归，判断在此类患者中，轻中度或中度FMR（2＋〈FMR≤3＋）预后的相关因素。方法2000年1月至2011年4月，74例重度主动脉瓣关闭不全合并左心室舒张期末径（LVEDD）≥70mm及左心室射血分数（LVEF）40．35，并伴2＋〈FMR≤3＋的患者。男61例，女13例。收集患者术前、术中及围手术期详细临床资料。术后进行随访。计算FMR术前／FMR术后比值，对年龄、性别、体质量、高血压、室性心律失常、房颤、LVEDD、LVEF、左心房内径（LAD）、肺动脉压（PAH）、二尖瓣对合点与瓣环水平间距离（CPMA）进行logistic多因素回归分析。结果围手术期死亡6例，病死率8．1％。术后平均随访（14．9±7．7）个月，随访率83．8％。随访期间死亡5例。多因素回归分析显示FMR术前／FMR术后与年龄、性别、体重、LVEDD≥75mm、LVEF≤0．30、高血压、室性心律失常不相关。而PAH≥50mmHg（1mmHg=0．133kPa）、LAD≥50mm、CPMA≥15mm、术前房颤与FMR术后改善呈负相关。结论重度主动脉瓣关闭不全合并左心室扩大及功能低下患者，如PAH≥50mmHg、LAD≥50mm、CPMA≥15mm、术前房颤，其伴随的轻中度或中度功能性二尖瓣反流在主动脉瓣置换术后通常不会改善甚至加重，应在行主动脉瓣置换术时同期治疗。Objective Functional mitral regurgitation （FMR） refers to the systolic regurgitation of mitral valve seconda- ry to compromised cardiac function or geometry abnormity with non-organic change of leaflets and ancillary parts of the valve. Severe aortic insufficiency （AI） with left ventricular dilation and dysfunction is clinically a complex heart disease and its post- operative complications and mortality are higher than usual valvular surgery. And such patients are often accompanied by FMR. It is generally acknowledged that FMR may improve after aortic valve replacement （AVR）. This study follow up M patients with left ventricular dilation and dysfunction and preoperative 2 ＋ 〈 FMR ≤ 3 ＋ to evaluate the outcome of FMR after AVR. Preoperative clinical data is assessed by regression analysis. Methods From January 2000 to April 2011,74 cases of patients were treated, who with severe aortic regurgitation combined with left ventricular dilation （left ventricle, LVEDD≥ 70 mm） and dysfunction （left ventricle ejection fraction, LVEF ≤ 0.35 ） accompanied by 2 ＋ 〈 FMR ≤3 ＋. Postoperative follow-up was performed. Calculation FMR preoperative/FMR postoperative ratio, the age, sex, weight, high blood pressure, ventricular ar- rhythmia, atrium fibrillation, LVEDD, LVEF, left atrium diameter（ LAD）, pulmonary artery pressure（ PAH）, mitral leaflet coaptation point and the mitral annular（CPMA）. All factors for logistic multiple faotors regression analysis. Results The pert- operative mortality rate was 8.1%. Average follow-up time was （14.9 ± 7.7） months and follow-up rate of 83.6%. 5 pa- tients died during follow-up. 6 months after surgery, the average of FMR was 2.64 ± 1.17 （ ＋ ）, P 〉 O. 05 compared with preoperative data. LVEDD, LAD, CPMA, P 〉 0.05 compared with the preoperative data. LVEF, PAH, both P 〈 0.05 com- pared with preoperative data. 3. Multiple regression analysis ： FMR preoperative/FMR postoperative ratio is not correlated with age, gender, weight

关 键 词：主动脉瓣闭锁不全 二尖瓣反流 左心室扩大 左心室收缩功能低下 

分 类 号：R654.2[医药卫生—外科学]