＂缘对缘＂技术防治二尖瓣成形术后收缩期前向运动及中远期随访结果  

Mid to long term results of ＂Edge to edge＂ technique in prevention or treatment for systolic anterior mo-tion after mitral valve repair

作　　者：鲍春荣[1] 梅举[1] 丁芳宝[1] 沈赛娥[2] 张韫佼[1] 汤敏[1] 朱家全[1] 马南[1] 张俊文[1] BAO Chun-rong MEI Ju DING Fang-boo et al(Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiootong University, Shanghai 200092, Chin)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092 [2]上海交通大学医学院附属新华医院麻醉科,上海市200092

出　　处：《中国心血管病研究》2017年第7期640-644,共5页Chinese Journal of Cardiovascular Research

基　　金：国家临床重点专科项目

摘　　要：目的 研究应用＂缘对缘＂技术防治二尖瓣成形术后收缩期前向运动（SAM）的疗效及中远期随访结果.方法 回顾性总结分析2006年1月至2015年12月我院应用＂缘对缘＂技术防治二尖瓣成形术后41例SAM患者的临床资料,其中男性25例、女性16例,年龄32~68（52.6±15.8）岁.二尖瓣成形手术技术包括后瓣叶矩形切除、人工腱索移植、采用成形环行瓣环成形等.将术前诊断有SAM和术中发现有SAM高危因素的患者归入预防组（n=32）,将术中二尖瓣成形后TEE检查发现有SAM经非手术处理无法纠正的患者归入治疗组（n=9）.在原有二尖瓣成形方法的基础上,应用4-0或5-0聚丙烯线于二尖瓣A2和P2相对应部分采用＂8＂字缝合方法,瓣叶上的缝合部位位于瓣叶对合线下方.结果 全组患者均成功完成二尖瓣成形术.所有病例均应用了二尖瓣成形环,采用＂C＂形环,成形环大小为26~32（29.2±2.8）mm.无手术死亡.术后2例轻度SAM,二尖瓣返流（MR）和左室流出道（LVOT）狭窄均为轻度.二尖瓣口平均跨瓣压差从（0.3±0.4）mm Hg上升到（2.2±1.5）mm Hg（P〉0.05）.MR程度从术前的3.5±0.9减少至0.7±0.6（P〈0.01）.术后早期有2例出现轻中度MR.术后随访（48.4±23.5）个月,随访中无新出现SAM,无MR或SAM需要再手术.5年免于再手术率100%.结论 应用＂缘对缘＂技术防治二尖瓣成形术后SAM安全、简便、有效,中远期随访疗效良好.Objective To study the result of＂Edge to edge＂ technique in prevention or treatment for sys-tolic anterior motion（SAM） after mitral valve（MV） repair. Methods We retrospectively analyzed the clinical data of 41 patients using ＂Edge to edge＂ technique in prevention or treatment for systolic anterior motion after mitral valve repair in our institurion from Jan. 2006 to Dec. 2015. Twenty-five males and 16 females aged of 32-68 （52.6 ±15.8）years were included. A variety of techniques were used to achieve a competent MV before using the＂Edge to edge＂ technique to manage SAM such as posterior leaflet quadrangular resection, neochordea, annulo-plasty with a semi-rigid ＂C＂ ring, etc. The cases diagnosed SAM before surgery or evaluated during surgery at high risk of developing SAM after MV repair were divided into the prevention group （n=32）. Patients in whom SAM was identified by TEE after initial termination of CPB after MV repair were in the treatment group（n=9）. 4-0 or 5-0 polypropylene suture was placed in a figure of 8 suture mode from A2 to P2 leaflet. Results MV repair was successfully completed in all patients.＂C＂ shape semi-rigid annuloplasty ring was used in every case. The size of ring was 26-32（29.2±2.8）mm. No death after surgery occurred. There were 2 mild SAM early after surgery with mild mitral regurgitation（MR） and mild left ventricular outflow tract（LVOT） obstruction. The mean MR grade de-creased from preoperative 3.5±0.9 （severe） to postoperative 0.7±0.6 （P〈0.001）. The mean transmitral gradient in-creased from preoperative（0.3±0.4）mm Hg to postoperative（2.2±1.5）mm Hg（P〉0.05）. At end of（48.4±23.5） months follow-up, moderate MR was in 2 patients, no SAM or MI over moderate was observed. The rate of free-dom from reoperation at 5 years in this group of patients was 100%. Conclusion The＂Edge to edge＂ technique is safe, simple, and effective in prevention or treatment for SAS after MV repair. And the mid to long term re

关 键 词：二尖瓣关闭不全 二尖瓣修复 收缩期前向运动 "缘对缘"技术 

分 类 号：R657.42[医药卫生—外科学]