重度主动脉瓣关闭不全合并中度功能性二尖瓣反流的临床研究

目的 探讨中度功能性二尖瓣反流（FMR）在重度主动脉瓣关闭不全患者中的处理原则及其近中期疗效。方法 分析2019年10月至2020年10月南京医科大学附属南京医院心胸血管外科16例重度主动脉瓣关闭不全合并中度功能性二尖瓣反流患者经手术治疗的临床资料。结果 所有术后患者围手术期无死亡，术后随访（2.9±1.7）个月，术后超声心动图提示FMR程度与术前相比较有所减轻，同时左心房内径（LAD）（P=0.01）、左心室舒张末期内径（LVEDD）（P=0.025）及左心室收缩末期内径（LVESD）（P=0.045）明显缩小，但LVEF较术前反而有所下降，但无统计学意义（P=0.259）。术后3~6个月随访，所有患者无复发，无需再次手术，复查超声心动图与术前比较LAD（P=0.022）、LVEDD（P=0.006）、LVESD（P=0.043）呈进行性缩小, 接近正常水平，EF较术前相比明显改善，有显著统计学差异（P=0.029） ，且FMR同步明显减轻。截至最后一次随访，5例二尖瓣无反流，7例微量反流，4例少量反流，手术成形效果满意。结论 重度主动脉瓣关闭不全合并中度的FMR建议积极行二尖瓣成形术处理，能够保留二尖瓣瓣膜的持久性和功能性，可获得较满意的近中期疗效。

The clinical study of severe aortic regurgitation with moderate functional mitral regurgitation

Objective To explore surgical principles and its near and medium-term efficacy in the treatment of patients with severe aortic regurgitation with moderate functional mitral regurgitation (FMR). Methods Clinical data of 16 patients who underwent operative treatment for severe aortic regurgitation with moderate functional mitral regurgitation between October 2019 and October 2020 in Nanjing Hospital Affiliated to Nanjing Medical University were retrospectively analyzed. Results There was no death in all the patients during the perioperative period, and the patients were followed up for (2.9±1.7) months. Echocardiography showed that the degree of functional mitral regurgitation (FMR) was reduced compared with preoperation, the left atrial diameter (LAD)(P=0.01) , left ventricular end-diastolic diameter (LVEDD) (P=0.025) and left ventricular end-systolic diameter (LVESD) (P=0.045) were significantly reduced, however, the left ventricular ejection fraction (LVEF) was decreased compared with preoperation, but there was no statistical significance (P=0.259). All patients were followed up 3-6 months after the operation, and no recurrence was required, compared with the preoperative level, the echocardiography revealed that LAD (P=0.022), LVEDD (P=0.006) and LVESD (P=0.043) were progressively reduced, and closed to the normal level, EF was significantly improved with significant difference (P=0.029), and FMR decreased synchronously. By the last follow-up, 5 patients had no regurgitation, 7 had tiny regurgitation and 4 had minimal regurgitation, and the results of operation were satisfactory. Conclusion Severe aortic regurgitation combined with moderate functional mitral regurgitatio is recommended to actively perform mitral valvuloplasty, and can retain its durability and functionality, and obtain the satisfactory early and mid-term effects.