二尖瓣成形术中使用二维平面人工环影响瓣环生理性空间构型  

The three dimensional annulus configuration changes after application of two dimensional artificial mitral annuloplasty

作　　者：张海波[1] 孟旭[1] 郭勇[2] 何怡华[2] 韩杰[1] 李岩[1] 

机构地区：[1]首都医科大学附属北京安贞医院心外科,100029 [2]首都医科大学附属北京安贞医院超声心动图科,100029

出　　处：《中华胸心血管外科杂志》2015年第5期270-273,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市自然科学基金（7112038）

摘　　要：目的 研究使用二维平面二尖瓣成形环对二尖瓣成形术后二尖瓣环三维空间构型的影响.方法 选取18～60岁单纯二尖瓣退行性变导致重度瓣膜反流患者,无其他合并心脏疾病.术前经食管三维超声心动图检测二尖瓣脱垂部位、反流程度、二尖瓣瓣环三维空间结构.二尖瓣成形术后同样进行三维食管超声心动图检测.应用SPSS 19.0软件进行统计学分析,所有测量数值以x±s表示,P＜0.05为差异有统计学意义.结果 入选二尖瓣成形病例42例,后叶脱垂28例,前叶脱垂14例,术中检测显示成形效果满意,二尖瓣无或微量反流.三维超声心动图检测显示二尖瓣环在心动周期中呈“马鞍形”,于前、后交界处较低,于前、后瓣环中点处较高.在收缩期前瓣环与后瓣环之间夹角较大,在舒张期,前叶侧瓣环与后叶侧瓣环之间夹角较小.二尖瓣成形术后二尖瓣瓣环周长、横径、纵径都较术前有减少.术前二尖瓣横径和纵径测量值几乎相同,提示重度反流时二尖瓣环变形为近乎圆形,成形术后则纵径/横径达到了0.88,提示二尖瓣环的纵径/横径比例有所恢复.瓣环高度降低由术前（8.4±0.6）mm降低到术后的（3.2±0.1）mm,瓣环高度/横径比值由术前0.24降低到0.15.收缩期前后瓣环非平面夹角由术前的（136±13）°增加为术后的（145 ± 14）°.结论 二尖瓣成形术中二维人工瓣环的使用可能会使瓣环空间构型发生平面化改变.Objective To investigate the mitral annular three dimensional configuration changes after application of two dimensional mitral annuloplasty.Methods Includes criteria：serious mitral prolapse without other cardiac disorders,with age ranged from 18 to 60 years old.Three dimensional echocardiography was performed before the surgery in the operation room.The mitral annular three dimensional configuration,the mitral prolapse and regurgitation grades were examined.And same procedure was done after the mitral repair.All the measure results were expressed as x ± s and the statistical analysis was performed using SPSS 19.0 software.Results Totally 42 cases were enrolled,including 28 posterior prolapse and 14 anterior prolapse cases.All the mitral repair got satisfied none or mild regurgitation.The mitral annulus moved consistently as saddle shape during the whole cardiac cycle,the lowest annulus part was at the commissure and the highest part was at the anterior and posterior annulus centers.During the systolic phase the non-planer angel between anterior and posterior annuls was bigger than in diastolic phase.The annulus circumference,transverse,longitudinal diameters decreased compared with before the surgery.Preoperative mitral transverse diameter and longitudinal diameter values are almost the equal size,indicating the mitral annulus was in nearly round shape.However the longitudinal/transverse ratio reached 0.88 after surgery which implied the annulus configuration recovery after annuloplasty.After the mitral annuloplasty the annular height decreased from （8.4 ± 0.6） mm to （3.2 ±0.1） mm while the annular height/transverse diameter ratio decreased from 0.24 to 0.15,which may be affected by the application of the two dimensional rigid artificial annulus.Non-planar angle between the anterior and posterior mitral annuls increased from（136 ± 13）degrees to（145 ± 14） degrees after mitral repair.Conclusion The mitral annulus configuration may have planarization changes due 1o the apply of two dimentiona

关 键 词：二尖瓣成形术 三维构型 人工瓣环 

分 类 号：R654.2[医药卫生—外科学]