瓣膜替换治疗二尖瓣狭窄用人工腱索保留瓣下结构的初步观察  

The preliminary results of prosthetic valve replacement for mitral stenosis using artificial chordae with preservation of the subvalvular apparatus.

作　　者：萧锡俊[1] 田子朴[1] 黄旭中[1] 石应康[1] 唐红[1] 刘淑华[1] 赁可[1] 宫友陵[1] 曹舸 

机构地区：[1]华西医科大学附属第一医院,四川成都610041

出　　处：《四川医学》2001年第1期10-11,共2页Sichuan Medical Journal

基　　金：四川省科委资助课题

摘　　要：目的　报告采用人工腱索替换保留瓣下结构的瓣膜置换治疗二尖瓣狭窄的初步结果。方法　采用可膨胀的聚四氟乙烯 (expanded polytetrafluoroethylene,e- PTEE)作为人工腱索 ,为 30例需切除瓣膜和腱索的单纯二尖瓣狭窄或二尖瓣狭窄伴返流的瓣膜病患者施行了人工腱索替换保留瓣下结构的瓣膜置换。人工腱索的长度以能产生适当的张力为宜。人工腱索多悬吊于前瓣环 ,但应以不影响人工瓣瓣叶活动为原则。结果　所有的患者均康复出院。随访时间 6～ 2 2月(平均 12 .1± 5 .4月 )。所有的患者均有显著的症状缓解及明显的心功能进步。结论　人工腱索替换保留瓣下结构的瓣膜置换治疗二尖瓣狭窄的初步结果是良好的。长期效果尚需进一步观察。Objective To report the preliminary results of prosthetic valve replacement for mitral stenosis using artificial chordae with preservation of the subvalvular apparatus.Methods 30 patients,whose mitral lesions were stenosis or associated with regurgitation,underwent mitral valve replacement using expanded polytetrafluoroethylene (e-PTEE) suture as artificial chordae with preservation of the subvalvular apparatus.The length of replaced chordae should be tight enough to generate some tension but should not be too short.Follow up studies including clinical examination and echocardiography were conducted 6 months after surgery.Results All patients were recovered.The follow-up time varied from 6 to 22 months (mean 12.1±5.4 months).The relief of symptoms and the significant improvement in heart function were observed in all patients.The left atrial diameter (LAD),left ventricular end-diastolic dimension (LVEDD),and left ventricular end-systolic dimension (LVESD) decreased significantly (LAD:from 54.5±10.4mm to 43.5±8.4mm,P<0.01;LVEDD:from 48.9±7.8mm to 45.7±6.3mm,P<0.05;LVESD:from 34.9±6.8mm to 32.2±6.4mm,P<0.05).ejection fraction (EF) increased from 54.7±9.5% to 57.4±9.1%,but no statistically significant difference was observed (P>0.05).There were no obvious changes in fractional shortening (FS:from 31.0±6.8% to 31.0±6.2%,P>0.05).The mean length of artificial chordac was 2.8±0.9cm(from 2.6cm to 4.3cm).None of the cases had obstruction of left ventricular outflow tract.[WT5”HZ]Conclusion It is believed that in these cases of mitral stenosis the prosthetic valve replacement using artificial chordae with preservation of the subvalvular apparatus has led to good preliminary results.

关 键 词：二尖瓣狭窄 瓣膜置换 人工腱索 瓣下结构 

分 类 号：R654.2[医药卫生—外科学]