二级腱索切断术在慢性缺血性二尖瓣关闭不全成形术中的初步应用  

Initial results of the second order chordal-cutting procedure for chronic ischemic mitral regurgitation

作　　者：韩庆奇[1] 徐志云[1] Han Qingqi;Xu Zhiyun(Department of Cardiovascular Surgery,Changhai Hospital,Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学长海医院心血管外科,上海200433

出　　处：《中华胸心血管外科杂志》2019年第11期675-679,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的初步评价二级腱索切断(CC)手术在慢性缺血性二尖瓣关闭不全(IMR)成形术中的安全性及有效性。方法全组共9例慢性IMR患者,在接受冠状动脉血运重建和瓣环成形术的基础上,同期行CC手术,手术适应证为二尖瓣反流(MR)程度中度(2+)以上,前瓣折角小于145°,对合深度小于10 mm。以围手术期病死率和严重并发症发生率以及术前、术后和随访期MR程度、心功能分级、前瓣折角、对合深度、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩期末期内径(LVESD)变化情况及趋势来评价其安全性及有效性。结果全组无围手术期死亡和严重并发症。MR程度由术前2.89±0.60降至0.56±0.70,心功能分级由术前2.78±0.07降至1.33±0.50,前瓣折角由术前(136.22±4.55)°恢复至(174.22±3.15)°,对合深度由术前(8.59±0.46)mm恢复至(1.54±0.68)mm,LVEF由术前0.49±0.07升至0.57±0.05,LVEDD由术前(62.78±5.24)mm减少至(53.67±2.99)mm,LVESD由术前(44.11±4.62)mm减少至(37.22±3.27)mm。结论对于慢性IMR,在冠状动脉血运重建和限制性瓣环成形术的基础上,同期行CC技术是安全的,而且能够显著提高近中期二尖瓣成形效果,促进心脏功能恢复。Objective To discuss and evaluate the safty and outcome of the second order chordal-cutting.Methods From Aug 2015 to Mar 2017,9 chronic IMR patients underwent chordal-cutting procedure,in addition to myocardial revascularization and undersized mitral annuloplasty.The indication was the presence of increased tethering of the anterior leaflet,with a bending angle(BA)<145°and the coaptation depth(CD)less than 10 mm.Pre-and post-procedure clinical data including left ventricular ejection fraction(LVEF),mitral regurgitation grade,New York Heart Association(NYHA)class and dimension of the left ventricle were compared.Results There was no perioperative death.No patient was lost to follow-up.MR grade decreased from 2.89±0.60 preoperatively to 0.56±0.70 postoperatively.The New York Heart Association class decreased from 2.78±0.70 preoperatively to 1.33±0.50 postoperatively.The BA increased from(136.22±4.55)°preoperatively to(174.22±3.15)°postoperatively.The coaptation depth decreased from(8.59±0.46)mm preoperatively to(1.54±0.68)mm postoperatively.LVEF increased from 0.49±0.07 preoperatively to 0.57±0.05 postoperatively.The diastolic and systolic diameters of left ventricle decreased from(62.78±5.24)mm to(53.67±2.99)mm and(44.11±4.62)mm to(37.22±3.27)mm,respectively.Conclusion In selected chronic IMR patients with a BA<145°and coaptation depth less than 10 mm,second order chordal-cutting can be a good surgical option,and is related to less MR return or persistence,improved LVEF,and lower New York Heart Association class.

关 键 词：慢性缺血性二尖瓣关闭不全 二级腱索切断术 外科手术 

分 类 号：R65[医药卫生—外科学]