二尖瓣成形术及二尖瓣置换术治疗风湿性二尖瓣病变的近期效果比较

目的 探究二尖瓣成形术及二尖瓣置换术治疗风湿性二尖瓣病变的近期效果。方法 选取2019年7月—2023年6月收治的风湿性二尖瓣病变患者400例作为研究对象。200例实施二尖瓣成形术（研究组）,200例实施二尖瓣置换术（对照组）,比较两组患者心功能、术中相关指标、住院时间、二尖瓣反流情况和并发生发生情况。结果 治疗前研究组左心室舒张内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、左房内径（LAD）与对照组比较差异无统计学意义（P>0.05）,治疗后研究组各指标均优于对照组（P<0.05）;研究组手术术中出血量和住院时间少于对照组,体外循环时间和手术时间长于对照组,差异有统计学意义（P<0.05）;研究组二发生3例二尖瓣中度反流,15例轻度反流,发生率低于对照组,差异有统计学意义（P<0.05）;研究组并发症发生率低于对照组,差异有统计学意义（P<0.05）。结论 二尖瓣成形术治疗风湿性二尖瓣病变效果更佳,可促进患者术后恢复,安全性高,心功能改善更明显,值得临床推广。     

二尖瓣关闭不全患者围术期左心功能改变的临床研究

目的研究二尖瓣关闭不全(mitral insufficiency,MI)患者围术期左心功能改变。方法 (1)术前根据左室舒张末期内径(LVEDD)大小将患者分成A、B 2组。(2)采用超声心动图测量2组患者术前及术后1周、2周、1个月、3个月的左房大小(LAD),左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD),左室射血分数(LVEF),左室短轴缩短率(LVFS)并进行对比分析。结果 2组患者术后LVEDD,LVESD,LAD都有减少趋势(P0.05);术后1周、2周LVEF,LVFS呈下降趋势(P0.05)。结论二尖瓣置换术(mitral valve replacement MVR)后1~2周时间左心功能会发生反复。对于心功能NYHAⅡ级,LVEF60%者应积极调整后手术。     

限制性二尖瓣环成形联合冠状动脉旁路移植术治疗缺血性二尖瓣反流

目的 探讨限制性二尖瓣环成形联合冠状动脉旁路移植术(CABG)治疗缺血性二尖瓣反流的近、中期效果及其在逆转左心室重构中的作用.方法 2000年1月至2008年6月,111例伴有中重度缺皿性二尖瓣反流的冠状动脉粥样硬化性心脏病患者接受限制性二尖瓣环成形联合CABG.男性81例,女性30例;平均年龄(63±18)岁.术前经胸超声心动图示二尖瓣反流中度7例,中重度65例,重度39例.比较患者手术前后及术后各时期经胸超声心动图资料.结果 院内死亡3例.术毕经食管心脏超声显示二尖瓣无反流69例,轻度反流34例,轻中度反流5例,中重度反流3例,该3例术中改行二尖瓣置换.术后3、12和24个月的生存率分别为96.2%、93.5%和89.7%.射血分数从术前的(46±6)%升至术后的(53±6)%(P＜0.01);左心房内径从术前(58±6)mm下降到术后(46±6)mm(P＜0.01);左心室舒张末内径从(61±8)mm下降到(48±10)mm(P＜0.01).术后二尖瓣反流程度明显下降(P＜0.01),心功能(NYHA分级)有明显改善(P＜0.01).24个月的随访期内,2例冉行二尖瓣置换术.结论 限制性二尖瓣环成形联合CABG治疗缺血性二尖瓣反流的近、中期效果满意,其对左心室重构有着明显逆转作用.

Abstract：

Objective To retrospectively summarize and analyze the short and mid term follow-up outcomes of combined coronary artery bypass grafting ( CABG) and restrictive mitral annuloplasty in curing ischemic cardiomyopathy and ischemic mitral regurgitation (IMR) , and to study its effect on reverse left ventricular remodeling. Methods From January 2000 to June 2008,111 patients of coronary artery disease with morderate to severe IMR underwent combined CABG and restrictive mitral annuloplasty, downsizing by 1-2 ring sizes. There were 81 male and 30 female patients. The age ranged from 36 to 83 years with a mean of (63 ± 18) years. Preoperative transthoracic echocardiography showed minimal to moderate IMR in 7 cases, moderate to severe in 65 cases and severe in 39 cases. The left artrial diameter (LAD) was (58 ±6) mm, left ventricular end-diastolic diameter (LVEDD) was (61 ±8) mm, left ventricular ejection fraction (LVEF) was 46% ±6%. Serial studies were performed to assess the survival rate, the extent of mitral regurgitation (MR), LVEF, the leaflet coaptation height, LAD, LVEDD, New York Heart Association (NYHA) functional class. Results Hospital mortality was 2.7% (3 cases). Each case received an undersized ring. Intraoperative transesophageal echocardiography showed that no regurgitation in 69 cases,minimal in 34 cases, minimal to moderate in 5 cases, moderate to severe in 3 cases which received mitral valve replacement. The 3-, 12- and 24-month survival rate was 96. 2% , 93. 5% and 89. 7% respectively.Mitral regurgitation grade decreased after the operative prodecures (P ＜0. 01). LVEF increased from (46 ± 6) % to (53 ±6) % (24 months follow-up) (F＜0. 01). LAD decreased from (58 ±6) mm to (46 ±6)mm(24 months follow-up) (P ＜0. 01). LVEDD decreased from (61 ±8) mm to (48 ± 10) mm (24 months follow-up) (P ＜ 0. 01 ) . There was no significant decline of LVEDD in 18 cases ( 16. 2% ) whose preoperative mean LVEDD was (69 ±9) mm. NYHA functional class improved after operative procedures ( P ＜ 0. 01) . At 24 months follow-up, 2 cases received valvular replacement Conclusions Combined CABG and restrictive mitral annuloplasty is a feasible and effective treatment for IMR, the short and mid term outcomes are satisfactory, and a significant reduction of LVEDD and an increase of LVEF due to reverse ventricular remodeling were observed.     

中-重度缺血性二尖瓣关闭不全外科治疗的中期效果

目的 探讨中-重度缺血性二尖瓣关闭不全（ischemic mitral regurgitation,IMR）患者治疗方案及疗效评价。方法 回顾性分析2014年6月—2019年6月于北部战区总医院接受外科治疗的冠状动脉粥样硬化性心脏病合并中-重度IMR患者的临床资料。按手术方式将患者分为两组：冠状动脉旁路移植术（coronary artery bypass grafting,CABG）组（CABG组），CABG+二尖瓣手术（mitral valve surgery,MVS）组（CABG+MVS组）。对两组患者的术前、术后临床资料进行对比分析。结果 共纳入105例患者，其中男75例、女30例，年龄40～79(62.70±7.90)岁。CABG组34例，CABG+MVS组71例（二尖瓣成形42例、二尖瓣置换29例）。围术期死亡5例，术后3个月死亡2例，7例均为CABG+MVS组患者，两组围术期和术后3个月死亡率差异无统计学意义（P=0.14）。中远期随访87例，两组患者术前二尖瓣反流程度（P=0.59）和左房内径（P=0.51）差异无统计学意义，而术后CABG组患者的二尖瓣反流程度明显大于C...     

保留二尖瓣装置的二尖瓣置换术

目的比较传统二尖瓣置换术(MVR)和保留二尖瓣装置的MVR治疗单纯风湿性二尖瓣狭窄的临床效果. 方法回顾性分析77例单纯风湿性二尖瓣狭窄行MVR患者的临床资料,按术式不同将其分为3组,组1:35例,保留全部二尖瓣装置;组2:19例,保留二尖瓣后瓣瓣下结构;对照组:23例,行传统MVR手术. 结果术后早期对照组和组1各死亡1例,晚期对照组死亡2例,组1和组2各死亡1例.术后3～16个月超声心动图检查显示,对照组和组2左心室舒张期末内径( LVEDD)较术前明显增大(P＜0.01),组1LVEDD 增大不明显(P＞0.01).组1、组2左心室射血分数 (EF)和短轴缩短率(FS)较术前有明显改善(P＜0.01),对照组改善不明显(P＞0.01). 结论单纯风湿性二尖瓣狭窄患者行MVR时保留二尖瓣装置有利于术后左心功能的恢复.     

保留后瓣及瓣下结构的二尖瓣置换术

目的总结保留后瓣及瓣下结构的二尖瓣置换术(MVR)的临床经验,并观察其与常规MVR比较的临床效果。方法风湿性心瓣膜病患者54例,其中行保留后瓣及瓣下结构的MVR24例(保留二尖瓣后瓣组),行常规MVR30例(常规手术组),观察两组患者术前、术后3个月的左心室舒张期末内径(LVEDD)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)等指标。结果保留二尖瓣后瓣组无死亡患者,常规手术组死亡1例;保留二尖瓣后瓣组术后血管活性药物的用量、种类和呼吸机使用时间较常规手术组减少;术后3个月保留二尖瓣后瓣组LVEDD较常规手术组减小,LVEF较常规手术组增大(P<0.05)。结论保留后瓣及瓣下结构的MVR手术操作不复杂,不增加心内手术时间,有可能减少左心室破裂的危险,术中操作仔细可以避免卡瓣,术后心功能恢复较好,更适用于心功能较差、左心室较大的以二尖瓣关闭不全为主的患者。     

冠心病合并缺血性二尖瓣关闭不全的处理方法

目的　探讨冠心病合并缺血性二尖瓣关闭不全 (IMR)病例 ,在行冠状动脉旁路移植术(CABG)时是否要对二尖瓣进行处理及最合适的处理方法。方法　回顾分析 2 0 0 0年 1月至 2 0 0 3年 1 0月期间连续行CABG者中 37例合并IMR者在不同手术处理前后的变化。结果　术前合并有轻 -重度IMR者中 2 4例仅行CABG ,无手术死亡 ,术后 1周左室舒张直径由 5 2 95mm降至 4 8 1 8mm(P =0 0 0 1 ) ,左室射血分数从 0 46上升到 0 5 5 (P <0 0 0 1 ) ,二尖瓣反流面积 (MR)由 3 93cm2 下降至 1 48cm2 (P <0 0 0 1 ) ;1 3例同期行CABG和二尖瓣成形或置换 ,手术死亡 1例。结论　缺血性心脏病合并无二尖瓣明显病理结构改变的IMR ,单纯行再血管化后左心室收缩功能改善、IMR短期内明显减轻或消失。中度以上IMR并有二尖瓣发生病理结构改变时 ,需同期对二尖瓣进行干预 ,但是手术死亡率较高。     

胸腔镜下二尖瓣成形术治疗二尖瓣狭窄的临床研究

目的:探讨胸腔镜下二尖瓣成形术治疗二尖瓣狭窄的临床效果。方法:回顾分析2016年3月至2019年4月收治的96例二尖瓣狭窄患者的临床资料,按治疗方式分为对照组(n=47)与研究组(n=49),对照组行开胸二尖瓣成形术,研究组行胸腔镜下二尖瓣成形术。对比两组手术情况、心肌酶、脑钠肽、心房利钠肽、超声心动图及并发症发生情况。结果:研究组手术时间、体外循环时间及升主动脉阻断时间长于对照组,差异有统计学意义(P0.05),切口范围、术中出血量、呼吸机辅助时间、重症监护室停留时间、引流管拔除时间、引流量及住院时间均少于对照组(P0.05)。术后,两组心肌酶水平均上升,研究组低于对照组(P0.05);两组脑钠肽、心房利钠肽水平均下降,组间差异无统计学意义(P0.05);两组心脏指数、二尖瓣口面积均上升,左心室舒张末期内径均缩小,组间相比差异无统计学意义(P0.05)。研究组并发症总发生率低于对照组,差异有统计学意义(P0.05)。结论:胸腔镜下二尖瓣成形术是治疗二尖瓣狭窄安全、有效的术式,能减轻手术创伤,促进术后康复。     

影响缺血性心肌病血运重建后左心室射血分数的多因素分析

目的探讨如何筛选出血运重建后左心室射血分数(LVEF)明显增加的缺血性心肌病(ischaemic cardiomyopathy,ICM)患者。方法回顾性分析我院2010年7月至2015年12月期间,245例行冠状动脉旁路移植术(coronary bypass grafting,CABG)(30%≤LVEF≤40%),其中合并缺血性二尖瓣反流146例(146/245,59.6%),有41例患者因中度以上的缺血性二尖瓣反流而同时行二尖瓣成形术/置换术。围术期死亡13例(12例为CABG+二尖瓣成形术或置换术,1例为单纯行CABG术),余232例随访6个月以上为研究对象,根据术后LVEF是否增加10%分为两组,即LVEF恢复组(A组)124例,LVEF不恢复组(B组)108例。结果单因素分析发现A组术前NT-proBNP值明显高于B组(P=0.036),有心肌梗死病史的比例明显低于B组(P=0.047),而术前仍有心绞痛的比例明显高于B组(P=0.024)。两组之间的二尖瓣反流程度及二尖瓣成形术或置换术比例差异无统计学意义(P=0.199)。A组患者的左心室舒张期末内径(LVEDD)、左心室收缩期末内径(LVESD)、左室舒张期末容积(LVEDV)均明显低于B组(P0.05)。多因素分析发现LVEDD明显增大、术前无明显心绞痛是ICM(30%≤LVEF≤40%)患者行血运重建后LVEF不能恢复的术前危险因素。以245例患者(包括13例围术期死亡患者)为研究对象,其LVEDD为41～71 mm,发现LVEDD≥60 mm与ICM患者的预后不良有显著关系(χ2=8.63,P=0.003,OR=2.21,95%CI 1.25～3.91)。结论发现LVEDD明显增大、术前无明显心绞痛是ICM(30%≤LVEF≤40%)患者行血运重建后LVEF不能恢复的术前危险因素。LVEDD≥60 mm可以作为ICM(30%≤LVEF≤40%)患者预后不良的术前临床筛选指标之一。     

二尖瓣成形术对轻中度缺血性二尖瓣关闭不全中期疗效的影响

目的评价单纯冠状动脉旁路移植术和同期加二尖瓣成形术对轻中度缺血性二尖瓣关闭不全（IMR）中期疗效的影响。方法1999年8月至2004年8月手术后生存的术前轻中度IMR病人60例，其中冠状动脉旁路移植术同期二尖瓣成形术（MVP组）和单纯冠状动脉旁路移植术（C组）各30例，分析术前资料，包括年龄、性别、二尖瓣反流程度、心功能、左心形态及左心室射血分数（LVEF）等，利用超声心动比较术后中期心功能和左心形态改善情况，利用生活质量评估表（SAQ量表）评价两组生活质量的改变。结果中期生存率MVP组为96．7％，C组为92．6％，两组差异无统计学意义。MVP组术后左心房内径缩小，C组左心房内径增大（P〈0．05），左心室内径改变两组差异无统计学意义。两组病人LVEF较术前均改善，但MVP组明显优于C组（P〈0．05）。MVP组术后生活质量明显优于C组病人，SAQ总得分分别为66．18和58．20（P〈0．05）。结论冠状动脉旁路移植术同期二尖瓣成形术可以明显提高轻中度IMR病人中期预后、生存率和生活质量，中期疗效优于单纯冠状动脉旁路移植术；     

部分可曲性人工二尖瓣瓣环成形技术的临床应用

目的 总结部分可曲性人工二尖瓣瓣环成形技术治疗二尖瓣关闭不全疾病的临床应用经验,探讨其治疗效果.方法 回顾性分析我院1998年1月～2006年8月施行部分可曲性人工瓣环二尖瓣成形术治疗259例二尖瓣疾病患者的临床资料,二尖瓣疾病的病理分类为风湿性二尖瓣狭窄或关闭不全16例,二尖瓣感染性心内膜炎16例,缺血性二尖瓣关闭不全13例,先天性二尖瓣关闭不全40例,退行性二尖瓣关闭不全174例.围术期采用超声心动图监测左心房(LA)、左心室舒张期末内径(LVEDD)、左心室收缩期末内径(LVESD)、左心室射血分数(LVEF)和左心室短轴缩短分数(LVFS)等指标;观察并记录围手术期和随访中生存率、二尖瓣反流率、二次手术率.结果 259例患者主动脉阻断时间为74±30min,体外循环时间为105±37min.术后围术期生存率为96.5%(250/259),无脑、肝、肾等重要器官并发症发生率为93.4% (242/259),无左室流出道梗阻、冠状动脉狭窄发生.术后随访45±28个月,随访60个月时的生存率为93.8%(243/259);无二次手术率为96.1%(249/259).术后LVEDD由术前的62.60±10.19mm缩小至52.88±8.67mm, LVEF由术前的57.91%增加为61.00%,均较术前明显改善(P＜0.05).随访中无或微量反流188例(72.6%),轻度反流62例(23.9%),中度反流8例(3.1%),重度反流1例(0.4%),二尖瓣反流程度较术前得到明显改善(P＜0.05).结论 这种部分可曲性人工二尖瓣瓣环成形技术操作简单,临床效果良好.     

非体外循环下采用自制二尖瓣成形装置手术治疗轻至中度缺血性二尖瓣关闭不全

目的尝试在非体外循环冠状动脉旁路移植术(OPCAB)期间对轻至中度缺血性二尖瓣反流(IMR)患者采用自制二尖瓣成形装置进行外科处理,并评估其疗效。方法回顾性分析自2009年9月至2011年8月北京安贞医院6例轻至中度IMR患者(男4例、女2例,年龄52～73岁)在OPCAB期间采用自制二尖瓣成形装置进行二尖瓣成形的临床资料。在处理IMR前及处理后通过经食管超声心动图测定IMR程度、二尖瓣瓣环前后径、左心室短轴径、左心室长轴径、左心室球形指数(左心室短轴径/左心室长轴径)等;通过Swan-Ganz导管测量并记录主动脉平均压、肺动脉平均压和中心静脉压等。比较围术期相关心功能指标。结果无住院死亡。二尖瓣成形后IMR均消失、二尖瓣瓣环前后径[(3.43±0.08)cm vs.(3.68±0.08)cm;t=5.430,P=0.001]、左心室短轴径[(4.80±0.21)cm vs.(5.53±0.11)cm;t=7.530,P=0.001]和左心室球形指数(0.64±0.02 vs.0.74±0.01;t=11.110,P=0.002)均较处理前明显减小;左心室长轴径无明显变化(P>0.05);术中血流动力学指标无明显变化。术后3个月6例患者(随访率100%)均在门诊复查,均无自主临床症状,心功能均改善至Ⅰ级(NYHA)。超声心动图提示:二尖瓣无反流4例,有微量反流2例。结论在OPCAB期间采用自制二尖瓣成形装置成形治疗IMR,直接完成了左心室塑型,规避了体外循环风险,即刻疗效确切,对循环指标影响甚小,有一定的临床应用价值。     

冠状动脉旁路移植同期行二尖瓣成形术治疗缺血性二尖瓣关闭不全

目的总结缺血性二尖瓣关闭不全（IMR）患者同期行冠状动脉旁路移植术（CABG）和二尖瓣成形术的临床经验,以提高手术疗效。方法对36例IMR行CABG加同期二尖瓣成形术患者的临床资料进行回顾性分析。共移植血管93支,平均每例2.58支。二尖瓣成形采用Carpentier环6例,Duran环14例,交界褥式环缩16例;edgetoedge技术6例,后叶楔形切除2例。结果住院死亡5例（13.89%）,死亡原因：低心排血量、循环功能衰竭、肾功能衰竭和脑梗死。术后随访21例,失访10例,随访时间26.4±5.6个月,远期死亡3例。生存患者心功能分级（NYHA）级14例,级3例,级1例。随访期间复查超声心动图提示：二尖瓣无反流或微量反流4例,轻度反流13例,中度反流4例;心功能明显改善。结论对冠状动脉多支病变合并中度IMR患者应慎重选择二尖瓣成形手术,单纯CABG可能是首选的治疗方案。CABG同期行二尖瓣成形术治疗IMR早期效果较好,远期复发率高,但多数患者不需再次手术治疗。     

冠心病合并慢性中度缺血性二尖瓣关闭不全的外科治疗

目的 探讨冠心病合并中度缺血性二尖瓣关闭不全(IMR)的外科治疗及其预后.方法 从1998年1月至2006年5月共收治冠心病合并中度IMR患者28例,均为冠状动脉病变合并单纯二尖瓣关闭不全,手术均在中度低温体外循环下行冠状动脉旁路移植术(CABG)和同期二尖瓣手术.二尖瓣成形术(MVP)24例,其中Reed法成形9例,Reed法成形同时加成形环8例,脱垂二尖瓣叶切除同时加成形环7例;二尖瓣置换术(MVR)4例,其中置换机械瓣1例,生物瓣3例.结果 术后早期无死亡患者,应用主动脉内球囊反搏(IABP)1例.术后随访26例,随访3～80个月,平均41个月,远期死亡2例(MVP 1例、MVR 1例).随访MVP患者生存22例,心功能Ⅰ级13 例,Ⅱ级6例,Ⅲ级3例,较术前明显改善;多普勒超声心动图检查二尖瓣无反流5例,微量反流7例,轻度反流6例,中度反流3例,重度反流1例,左房容积(LAV)54.1±12.7ml,左心室舒张期末容积(LVEDV)60.9±14.8 ml,左心室射血分数(LVEF)0.59±0.15,与术前比较差异均有统计学意义(P＜0.05).随访MVR患者生存2例,心功能Ⅰ级1 例,Ⅱ级1例;多普勒超声心动图检查瓣膜功能良好.结论 对冠心病合并中度IMR患者应在行CABG时同期进行处理,IMR处理的方法以MVP同时加用成形环的早期临床效果较好,但是对左室功能差和左室壁运动异常的患者远期效果需要进一步观察.     

乳头肌瓣环固定技术在二尖瓣置换术中的应用

目的分析乳头肌瓣环再固定(papillary muscle repositioning,PMR)技术在二尖瓣置换术中应用的可行性。方法回顾性分析2016年3月至2017年3月,以二尖瓣病变为主并实施PMR技术的瓣膜置换术(均置换的机械瓣膜)19例患者的临床资料,其中男10例、女9例,年龄(52.46±11.22)岁。分析其心功能改善情况及左心室形态等手术效果。结果患者围手术期死亡0例;开胸止血1例,低心排血量综合征(低心排)1例,强心利尿后好转,并顺利出院。术后仅1例出现大量血管活性药物的应用。心脏超声随访结果显示术后6个月左心室射血分数(LVEF)均较术前改善,出院前较术前降低;左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)较术前减小,差异具有统计学意义(P0.05)。结论实施PMR技术的二尖瓣置换术在维持左心室乳头肌-二尖瓣环的张力和完整性,改善左室容积、左室形态和射血分数方面效果良好。     

亚急性心肌梗死合并重度缺血性功能性二尖瓣关闭不全的处理方式探讨

目的 探讨亚急性心肌梗死合并重度二尖瓣关闭不全患者的处理方法及手术时机. 方法 2005年1月至2011年12月北京安贞医院采用外科手术治疗89例亚急性心肌梗死合并重度二尖瓣关闭不全患者[男66例,女23例；平均年龄64(55～73)岁].所有患者手术前先用药物治疗3个月后行单纯冠状动脉旁路移植术,二尖瓣病变未做处理.就诊时、术前和术后6个月做超声心动图检查,观察二尖瓣反流情况,并检测左心室收缩期末内径、左心室舒张期末内径和左心室射血分数(LVEF). 结果 无手术死亡,无围术期心肌缺血和其它严重并发症发生.随访81例(91.0％),随访时间6～60个月,术后6个月二尖瓣反流面积[(3.1±1.3) cm2 vs.(5.6±2.3)cm2]、左心室舒张期末内径[(51.3±4.2) mm vs.(54.3±5.5)mm]和左心室收缩期末内径[(31.7±3.9) mm vs.(34.6±4.3) mm]均较术前明显减小(P＜0.05),而术后6个月LVEF与术前比较差异无统计学意义(59.1％±3.9％vs.58.9％±5.6％,P＞ 0.05).术后3年起,随访患者每年行冠状动脉血管CT检查1次,未发现移植血管存在明显狭窄(狭窄＞50％). 结论 对亚急性心肌梗死合并重度二尖瓣关闭不全患者,适当的延缓手术,结合正确的药物治疗,可能不再需要同期处理二尖瓣病变,可降低手术风险,减少医疗费用.     

限制性二尖瓣环成形联合冠状动脉旁路移植术治疗缺血性二尖瓣反流

Objective To retrospectively summarize and analyze the short and mid term follow-up outcomes of combined coronary artery bypass grafting ( CABG) and restrictive mitral annuloplasty in curing ischemic cardiomyopathy and ischemic mitral regurgitation (IMR) , and to study its effect on reverse left ventricular remodeling. Methods From January 2000 to June 2008,111 patients of coronary artery disease with morderate to severe IMR underwent combined CABG and restrictive mitral annuloplasty, downsizing by 1-2 ring sizes. There were 81 male and 30 female patients. The age ranged from 36 to 83 years with a mean of (63 ± 18) years. Preoperative transthoracic echocardiography showed minimal to moderate IMR in 7 cases, moderate to severe in 65 cases and severe in 39 cases. The left artrial diameter (LAD) was (58 ±6) mm, left ventricular end-diastolic diameter (LVEDD) was (61 ±8) mm, left ventricular ejection fraction (LVEF) was 46% ±6%. Serial studies were performed to assess the survival rate, the extent of mitral regurgitation (MR), LVEF, the leaflet coaptation height, LAD, LVEDD, New York Heart Association (NYHA) functional class. Results Hospital mortality was 2.7% (3 cases). Each case received an undersized ring. Intraoperative transesophageal echocardiography showed that no regurgitation in 69 cases,minimal in 34 cases, minimal to moderate in 5 cases, moderate to severe in 3 cases which received mitral valve replacement. The 3-, 12- and 24-month survival rate was 96. 2% , 93. 5% and 89. 7% respectively.Mitral regurgitation grade decreased after the operative prodecures (P ＜0. 01). LVEF increased from (46 ± 6) % to (53 ±6) % (24 months follow-up) (F＜0. 01). LAD decreased from (58 ±6) mm to (46 ±6)mm(24 months follow-up) (P ＜0. 01). LVEDD decreased from (61 ±8) mm to (48 ± 10) mm (24 months follow-up) (P ＜ 0. 01 ) . There was no significant decline of LVEDD in 18 cases ( 16. 2% ) whose preoperative mean LVEDD was (69 ±9) mm. NYHA functional class improved after operative procedures ( P ＜ 0. 01) . At 24 months follow-up, 2 cases received valvular replacement Conclusions Combined CABG and restrictive mitral annuloplasty is a feasible and effective treatment for IMR, the short and mid term outcomes are satisfactory, and a significant reduction of LVEDD and an increase of LVEF due to reverse ventricular remodeling were observed.     

限制性二尖瓣环成形联合冠状动脉旁路移植术治疗缺血性二尖瓣反流

Objective To retrospectively summarize and analyze the short and mid term follow-up outcomes of combined coronary artery bypass grafting ( CABG) and restrictive mitral annuloplasty in curing ischemic cardiomyopathy and ischemic mitral regurgitation (IMR) , and to study its effect on reverse left ventricular remodeling. Methods From January 2000 to June 2008,111 patients of coronary artery disease with morderate to severe IMR underwent combined CABG and restrictive mitral annuloplasty, downsizing by 1-2 ring sizes. There were 81 male and 30 female patients. The age ranged from 36 to 83 years with a mean of (63 ± 18) years. Preoperative transthoracic echocardiography showed minimal to moderate IMR in 7 cases, moderate to severe in 65 cases and severe in 39 cases. The left artrial diameter (LAD) was (58 ±6) mm, left ventricular end-diastolic diameter (LVEDD) was (61 ±8) mm, left ventricular ejection fraction (LVEF) was 46% ±6%. Serial studies were performed to assess the survival rate, the extent of mitral regurgitation (MR), LVEF, the leaflet coaptation height, LAD, LVEDD, New York Heart Association (NYHA) functional class. Results Hospital mortality was 2.7% (3 cases). Each case received an undersized ring. Intraoperative transesophageal echocardiography showed that no regurgitation in 69 cases,minimal in 34 cases, minimal to moderate in 5 cases, moderate to severe in 3 cases which received mitral valve replacement. The 3-, 12- and 24-month survival rate was 96. 2% , 93. 5% and 89. 7% respectively.Mitral regurgitation grade decreased after the operative prodecures (P ＜0. 01). LVEF increased from (46 ± 6) % to (53 ±6) % (24 months follow-up) (F＜0. 01). LAD decreased from (58 ±6) mm to (46 ±6)mm(24 months follow-up) (P ＜0. 01). LVEDD decreased from (61 ±8) mm to (48 ± 10) mm (24 months follow-up) (P ＜ 0. 01 ) . There was no significant decline of LVEDD in 18 cases ( 16. 2% ) whose preoperative mean LVEDD was (69 ±9) mm. NYHA functional class improved after operative procedures ( P ＜ 0. 01) . At 24 months follow-up, 2 cases received valvular replacement Conclusions Combined CABG and restrictive mitral annuloplasty is a feasible and effective treatment for IMR, the short and mid term outcomes are satisfactory, and a significant reduction of LVEDD and an increase of LVEF due to reverse ventricular remodeling were observed.     

限制性二尖瓣环成形联合冠状动脉旁路移植术治疗缺血性二尖瓣反流

Objective To retrospectively summarize and analyze the short and mid term follow-up outcomes of combined coronary artery bypass grafting ( CABG) and restrictive mitral annuloplasty in curing ischemic cardiomyopathy and ischemic mitral regurgitation (IMR) , and to study its effect on reverse left ventricular remodeling. Methods From January 2000 to June 2008,111 patients of coronary artery disease with morderate to severe IMR underwent combined CABG and restrictive mitral annuloplasty, downsizing by 1-2 ring sizes. There were 81 male and 30 female patients. The age ranged from 36 to 83 years with a mean of (63 ± 18) years. Preoperative transthoracic echocardiography showed minimal to moderate IMR in 7 cases, moderate to severe in 65 cases and severe in 39 cases. The left artrial diameter (LAD) was (58 ±6) mm, left ventricular end-diastolic diameter (LVEDD) was (61 ±8) mm, left ventricular ejection fraction (LVEF) was 46% ±6%. Serial studies were performed to assess the survival rate, the extent of mitral regurgitation (MR), LVEF, the leaflet coaptation height, LAD, LVEDD, New York Heart Association (NYHA) functional class. Results Hospital mortality was 2.7% (3 cases). Each case received an undersized ring. Intraoperative transesophageal echocardiography showed that no regurgitation in 69 cases,minimal in 34 cases, minimal to moderate in 5 cases, moderate to severe in 3 cases which received mitral valve replacement. The 3-, 12- and 24-month survival rate was 96. 2% , 93. 5% and 89. 7% respectively.Mitral regurgitation grade decreased after the operative prodecures (P ＜0. 01). LVEF increased from (46 ± 6) % to (53 ±6) % (24 months follow-up) (F＜0. 01). LAD decreased from (58 ±6) mm to (46 ±6)mm(24 months follow-up) (P ＜0. 01). LVEDD decreased from (61 ±8) mm to (48 ± 10) mm (24 months follow-up) (P ＜ 0. 01 ) . There was no significant decline of LVEDD in 18 cases ( 16. 2% ) whose preoperative mean LVEDD was (69 ±9) mm. NYHA functional class improved after operative procedures ( P ＜ 0. 01) . At 24 months follow-up, 2 cases received valvular replacement Conclusions Combined CABG and restrictive mitral annuloplasty is a feasible and effective treatment for IMR, the short and mid term outcomes are satisfactory, and a significant reduction of LVEDD and an increase of LVEF due to reverse ventricular remodeling were observed.     

非体外循环冠状动脉旁路移植术后缺血性二尖瓣关闭不全患者的心功能改变

目的探讨非体外循环冠状动脉旁路移植术(off-pump CABG)对缺血性二尖瓣关闭不全患者心功能改变的影响,以提高治疗效果。方法53例缺血性二尖瓣关闭不全患者,男45例,女8例;年龄51～73岁,平均年龄63.3岁。53例患者均行off-pump CABG,术前及术后12个月分别采用超声心动图检测心功能改变及二尖瓣反流情况。结果术后3h死于突发心室颤动1例;术后发生大出血1例,于术后6h行二次开胸止血手术。随访52例,随访时间12个月,其中行超声心动图检查48例。术后12个月左心室收缩期末内径(34.75±6.83mm vs.38.80±7.21mm,t=-3.550,P=0.001),左心室舒张期末内径(50.50±10.31mm vs.53.85±11.20mm,t=-6.364,P=0.000)和二尖瓣反流面积(25.32%±9.80% vs.29.45%±12.30%,t=2.129,P=0.001)均较术前减小,左心室射血分数(62.10%±24.20% vs.57.75%±22.10%,t=2.132,P=0.038)较术前增加。结论冠心病合并中度二尖瓣关闭不全患者行off-pump CABG术后12个月二尖瓣反流量减少,左心室功能改善。