二尖瓣替换术保留瓣下结构对维护术后早期左心室几何形态的重要性  

The Importance of Mitral Valve Replacement with Preservation of Subvalvular Apparatus on Left Ventricular Ge- ometry at Early postoperative Period

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

机构地区：[1]上海医科大学附属中山医院,上海市心血管病研究所上海200032 [2]天津市胸科医院

出　　处：《中国心血管杂志》2000年第3期150-154,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 比较、分析33例慢性二尖瓣返流病例分别行传统的二尖瓣替换术(MVR)(组1,n=11例)、保留后叶腱索的MVR(组2,n=11例)和保留前、后叶腱索的MVR(组3,n=11例)术后早期左心室几何形态的变化.方法应用超声心动技术测量术前、术后10天左心房内径(LAD),左心室短轴舒张末、收缩末内径(LVEDD,LVESD)和左心室长轴舒张末、收缩末纵径(LVEDL,LVESL)的变化.结果 术前三组间无显著性差异.术后三组LAD均较术前明显缩小(分别为P<0.01,P<0.01和P<0.05),三组间无显著性差异.三组LVEDD均明显回缩(分别为P<0.01,P<0.01和P<0.05);LVESD也缩小,但仅组3与术前比较呈显著性差异(P<0.05)组1 LVEDL和LVESL均明显增加(P<0.05);组2无明显改变;组3明显缩短(分别为P<0.05和<0.01),且与组1比较呈显著性差异(P<0.05).结论 保留瓣下结构的MVR(P-MVR)矫治慢性二尖瓣返流对术后早期左心室几何形态具有维护作用,尤其体现在防止左心室长轴的纵向扩张.MVR时保留前、后叶腱索对左心室几何形态的维护更为完善,在防止左心室长轴纵向扩张的同时,促进左心室长、短轴的缩短.Objective To compare and analyze the changes of left ventriular geometry in 33 patients who underwent conventional mitral valve replacement (MVR) (group1, n=11), MVR with preservation of posterior chordae tendineae alone (group2. n=11) and MVR with preservation of both anterior and posterior chordae tendineae (group3,n= 11) respectively for chronic mitral regurgitayion at early postoperative period. Methods Left atrial diameter (LAD), the end diastolic and systolic diameters of left ventricular short axis (LVEDD, LVESD) and the end diastolic and systolic lengths of left ventricular long axis(LVEDL, LVESL) were measured by echocardio-graphyat preoperative and 10 days postoperative periods. Results There was no significant difference between the three groups before operation. Postoperatively, LAD decreased significantly in all three groups (P<0. 01; P<0. 01 and P<0. 01, respectively), and no significant difference was seen between the groups. LVEDD shortened significantly in the three groups (P<0. 01; P<0. 0land P<0. 05, respectively) ; and LVESD shortened either, however, a significant decrease was only shown in group3 (P<0. 05). Both LVEDL and LVESL increased significantly in groupl (P<0. 05); no changes in group2; and shortened significantly in group3 (P<0. 05;P<0. 01,respectively ), and there was a significant difference compared with groupl (P<0. 05). Conclusion This study indicates that MVR with preservation of subvalvular apparatus has beneficial effects on maintaining left ventricular geometry at early postoperative period, which is more impressive with preventing from longitudinal elongation of the left ventricular long axis; and that MVR with preservation of both anterior and posterior chordae tendineae shows more evident effects than MVR with preservation of posterior chordae tendineae alone on maintaining left ventricular geometry, it not only prevents from longitudinal elongation of the left ventricular long axis, but also improves contraction of the left ventricular long and short axes.

关 键 词：慢性二尖瓣返流 二尖瓣替换术 瓣下结构保留 左心室几何形态 

分 类 号：R654.2[医药卫生—外科学]