评价原位完整保留瓣下结构的二尖瓣替换术  

Assessment of Mitral Valve Replacement with Preservation of Subvalvular Apparatus at Anatomic Position

作　　者：于昂[1] 王敏生[2] 王春生[2] 赵强[2] 沈学东[2] 潘翠珍[2] 

机构地区：[1]天津市胸科医院,天津300051 [2]复旦大学附属中山医院上海市心血管病研究所,上海200032

出　　处：《中国临床医学》2001年第4期323-325,共3页Chinese Journal of Clinical Medicine

摘　　要：目的 :总结 11例二尖瓣替换术 (MVR)原位保留瓣下结构的方法和技术要点 ;评价其对术后早期左心室收缩、泵血功能的影响 ;探讨潜在的合并症。方法 :部分切除二尖瓣前叶 ,分别将残留前叶及全部腱索和完整后叶及腱索重新缝合、固定在前、后叶原瓣环上。术后 10d应用超声心动技术观测左心室舒张末、收缩末容积指数 (LVEDVI ,LVESVI) ,射血分数 (LVEF) ,峰值排空率 (LVPER)、左心室流出道 (LVOT)收缩期血流速度和残留前叶的前向运动 (SAM )。结果 :本组病例无手术死亡或严重合并症。术后LVEDVI,LVESVI均明显降低 (均为P <0 .0 1) ,LVEF和LVPER明显高于术前 (均为P <0 .0 5 )。收缩期LVOT血流速度无明显加快 ;无SAM现象。结论 :原位保留二尖瓣前、后叶腱索的MVR技术并不复杂 ,易推广。对术后早期左心室收缩、泵血功能具有明显的维护、改善作用。无人工机械瓣膜运动障碍 ;Objective: To sum up the operative skills and special details of the technique, evaluate the effect on left ventricular systolic and pump functions and discuss the potential complications in 11 patients who underwent mitral valve replacement(MVR) with total preservation of subvalvular apparatus at anatomic position. Methods: The anterior mitral leaflet was partially excised. The remained anterior mitral leaflet with whole chordae tendineae and the entire posterior mitral leaflet with its chordae tendineae were resuspended at anterior and posterior mitral annulus respectively. The end diastolic and systolic left ventricular volume indexes(LVEDVI, LVESVI), left ventricular ejection fraction(LVEF), the peak of emptying rate of the left ventricle (LVPER)and the blood flow velocity in left ventricular outflow tract (LVOT) were measured by echocardiography 10 days after operation.Results: No mortality or severe complications related to this new technique happened. Both LVEDVI and LVESVI decreased significantly ( P<0.01, respectively), and both LVEF and LVPER increased significantly ( P<0.05, respectively). No signs suggested accelerations in LVOT blood flow velocity and systolic anterior motion (SAM) of the remaining anterior leaflet.Conclusion: This new technique is not difficult to master up, and it is easy to reproducibility. The motive obstacle of prostheses is not observed during operation and after operation by echocardiographic examination, but the LVOT obstruction may be a potential complication.

关 键 词：慢性二尖瓣返流 二尖瓣替换术 保留瓣下结构 MVR 

分 类 号：R654.2[医药卫生—外科学]