二尖瓣成形术治疗感染性心内膜炎(IE)的中长期疗效

 目的  总结二尖瓣成形术治疗感染性心内膜炎(infective endocarditis,IE)的中长期疗效。方法  回顾性分析复旦大学附属中山医院心外科2005年1月至2012年12月运用二尖瓣成形术治疗单纯累及二尖瓣的IE患者28例,占同期手术治疗单纯累及二尖瓣感染性心内膜炎的24.1%。切除瓣体及瓣缘赘生物后,行缘对缘缝合2例,穿孔缝合2例,前叶植入人工腱索5例,前叶三角形切除6例,后叶楔形切除16例,植入人工二尖瓣成形环28例。结果  全组无手术死亡。术后即刻经食道超声心动图示25例无反流,3例轻微反流。随访28例,随访时间15~111 (54.7±34.2)个月,无复发,无再次手术,无死亡。术后随访经胸超声心动图,随访时间1~87 (26.6±27.9)个月,无反流9例,轻微反流18例,轻中度反流1例。结论  二尖瓣成形术治疗二尖瓣IE具有满意的中长期疗效。对于二尖瓣结构未被严重破坏的IE患者,可尝试二尖瓣成形术。

Mid-long term outcomes of mitral valve reconstruction for infective endocarditis (IE)

Objective  To investigate the mid-long term outcomes of mitral valve reconstruction for infective endocarditis (IE).Methods  Twenty-eight patients with IE who underwent valve reconstruction for isolated mitral IE were reviewed.All the patients were admitted in Zhongshan Hospital during Jan.,2005 and Dec.,2012.Reconstruction techniques included edge-to-edge (n=2),closure of perforation (n=2),artificial chordae (n=5),anterior leaflet triangular resection (n=6),posterior leaflet quadrangular resection (n=16) and prosthetic ring annuloplasty (n=28).Results  No hospital deaths and reoperation for recurrent mitral regurgitation occurred among the 28 patients.Transesophageal echocardiography showed no regurgitation (n=25)and trivial regurgitation (n=3) after valve reconstruction immediately.Transthoracic echocardiography demonstrated no regurgitation (n=9),trivial regurgitation (n=18) and mild moderate regurgitation (n=1) at the last follow-up examination of 1-87 (26.6±27.9) months after surgery.No cases of recurrent infection occurred and no patients died.Conclusions  Mid-long term outcomes of mitral valve reconstruction for IE were satisfied.When technically feasible,surgeons could try mitral valve reconstruction to treat IE patients without seriously damged mitral valve.