二尖瓣成形术治疗二尖瓣反流89例临床分析

目的总结二尖瓣成形术治疗二尖瓣反流患者的临床经验,分析其疗效。方法回顾性分析2007年1月至2011年7月中国医科大学附属第一医院采用二尖瓣成形术治疗89例二尖瓣中重度反流患者的临床资料,其中男51例,女38例;年龄21～64(48.6±13.6)岁;病程1周～21年。术前经食管超声心动图及术中探查发现二尖瓣中度反流(Ⅲ级)40例,重度反流(Ⅳ级)49例。56例二尖瓣脱垂,脱垂病变累及A2区4例、A3区5例、P2区25例、P3区14例,累及多处8例;其中二尖瓣腱索断裂37例,腱索冗长脱垂19例;瓣环扩大42例。手术方式:前叶腱索转移4例,前叶人工腱索6例,前叶裂缝合2例,交界部缝合6例,后叶矩形切除加Sliding(滑行)技术43例,后叶折叠缝合成形14例,后叶人工腱索12例,缘对缘成形10例和心包补片修补瓣叶穿孔1例,其中2种以上修复方式9例。全部患者均使用成形环加固瓣环。手术中应用注水试验和食管超声心动图检查评价成形效果。结果无围术期死亡。术后心脏超声心动图提示:二尖瓣无反流(0级)15例,微量反流(Ⅰ级)41例,轻度反流(Ⅱ级)23例,轻至中度反流(Ⅲ级)10例。所有患者均无二尖瓣狭窄。术后随访77例(86.52%),随访时间3～58(12.3±18.7)个月。随访期间1例死于脑血管意外;1例行二尖瓣置换术。结论综合运用多种二尖瓣成形技术治疗二尖瓣中重度反流,可获得良好的临床疗效。     

部分型房室间隔缺损二尖瓣处理策略

目的总结部分型房室间隔缺损（PAVSD）患者外科手术的近远期疗效,探讨二尖瓣处理方法。方法回顾性分析1990年1月至2008年12月于第二军医大学长海医院行外科治疗PAVSD患者118例的临床和随访资料,男51例,女67例;年龄7个月~62岁（28.5±12.6岁）。均有原发孔型房间隔缺损和不同程度的二尖瓣前瓣裂隙,其中二尖瓣中重度反流78例,三尖瓣中重度反流56例。手术均在中度低温体外循环下进行。术后通过门诊和电话随访。结果术后早期死亡2例,病死率1.69%。发生其他严重并发症为再次气管内插管5例,左心辅助1例,Ⅲ°房室传导阻滞1例。术后随访103例,随访时间3个月~18年（91.2±25.6个月）。再次手术8例,距第一次手术时间为5 d~18年（10.5±5.6年）。再次手术死亡1例。随访生存的102例患者生活质量均有明显改善。二尖瓣无反流70例,微量和轻度反流17例,中度4例。行二尖瓣置换术患者瓣膜功能良好,无抗凝相关并发症。心房颤动19例,Ⅰ°房室传导阻滞21例,频发性房性早搏4例。结论二尖瓣修复是PAVSD矫治手术成功的关键,应综合应用二尖瓣成形修复的方法,尽量消除二尖瓣反流;术后二尖瓣再反流是再次手术的主要原因,对中重度二尖瓣反流患者应定期随访和及时手术。     

二尖瓣反流机制的再认识:从二维世界到四维时空

二尖瓣反流(mitral regurgitation,MR)是一种发病机制比较复杂的瓣膜性心脏病。但是,目前临床对MR的理解多停留在单纯空间的角度。我们建议对于MR的评估要突破二维单帧的面积局限思维,过渡到三维空间-时间积分(也就是四维时空)的全面评估。其次,要注意MR发生的时间机制及时间思维,不同心动周期、同一心动周期内,MR量可能有所不同。由于心脏收缩在时间维度上的变化可导致MR的发生,有时需要从时间思维而不是空间思维去理解MR。     

二尖瓣修复术治疗感染性心内膜炎所致二尖瓣反流患者

目的探讨二尖瓣修复及置换术对感染性心内膜炎所致二尖瓣反流患者的疗效。 方法选取2014年1月至2016年1月于淄博市中心医院就诊的126例感染性心内膜炎所致二尖瓣反流患者为研究对象,根据治疗过程中手术方式不同分为研究组和对照组（各63例）,研究组患者采取二尖瓣修复术进行治疗,对照组患者采取二尖瓣置换术进行治疗。详细记录入组患者的气管插管时间、入住重症加强护理病房（ICU）时间、感染发生率、手术患者病死率、住院天数、住院花费等;记录患者心脏超声检查结果：左心室射血分数、左心室舒张末期直径、左心室收缩末期直径、左心房直径及二尖瓣反流得分,并记录随访指标。 结果与对照组患者相比,研究组患者气管插管时间[（16.48 ± 8.06）h]、入住ICU时间[（2.12 ± 0.86）h]、术后病死率（1.59%）、住院时间[（22.46 ± 10.34）d]、栓塞发生率（4.76%）以及住院花费[（10.63 ± 3.57）万元]差异均有统计学意义（t = 1.35、P = 0.04,t = 3.68、P = 0.02,χ² = 4.67、P = 0.01,t = 4.03、P = 0.01,χ² = 1.69、P = 0.04,t = 3.06、P = 0.03）;研究组患者术后左心室射血分数[（49.06 ± 10.24）%]、左心房直径[（43.25 ± 8.98）mm]和二尖瓣反流得分[（1.12 ± 0.31）分]均小于对照组患者,左心室舒张末期直径[（52.46 ± 7.42）mm]和左心室收缩末期直径[（39.70 ± 8.09）mm]均大于对照组患者,差异均有统计学意义（t = 1.23、2.84、3.89、1.34、2.01,P = 0.04、0.02、0.01、0.03、0.02）。随访显示,研究组患者左心室射血分数[（61.38 ± 8.61）%]大于对照组患者（t = 5.31、P = 0.01）,左心室舒张末期直径[（48.69 ± 9.57）mm]和随访病死率（4.76%）均小于对照组,差异有统计学意义（t = 3.24、P = 0.02,χ² = 2.91,P = 0.03）。单因素方差分析显示入住ICU时间、插管时间和心功能衰竭史均为感染性心内膜炎患者手术死亡危险因素（t = 2.34、P = 0.01,t = 1.09、P = 0.03,χ² = 1.61、P = 0.02）。 结论二尖瓣修复术对感染性心内膜炎所致二尖瓣反流疗效和预后较好,能够缩短患者住院时间和降低入院费用。     

标准化二尖瓣修复策略在完全房室间隔缺损术后左侧房室瓣反流治疗中的应用

目的 总结阜外医院标准化二尖瓣修复策略治疗完全房室间隔缺损(CAVSD)术后严重左侧房室瓣反流(LAVVR)的应用经验.方法 回顾性分析2016-2019年于我院通过标准化二尖瓣修复策略治疗CAVSD术后LAVVR的11例患者临床资料,其中男5例、女6例,中位年龄56(22～ 152)个月.总结二尖瓣大量反流病理特征、...     

Marfan综合征合并二尖瓣反流的外科治疗

Ｍａｒｆａｎ综合征心血管系统的主要表现为主动脉根部扩张与主动脉瓣关闭不全 ,二尖瓣可同时受累 ,导致功能损害 ,病人因二尖瓣关闭不全而需手术治疗。 1 997年 1 0月至 2 0 0 1年 4月间 ,我们对 1 0例Ｍａｒｆａｎ综合征病人在实施主动脉根部置换术 (Ｂｅｎｔａｌｌ手术 )的同时 ,进行了二尖瓣置换术 (ＭＶＲ)或二尖瓣成形修复术 (ＭＶＰ) ,获得了良好的临床效果。资料和方法　 1 0例病人中男 7例 ,女 3例。年龄 2 6～ 58岁 ,平均 (43 3± 9 4)岁 ;体重 50～ 65ｋｇ ,平均 (60 6± 4 8)ｋｇ ;平均身高 (1 79 1± 3 1 )ｃｍ。主要临床表现…     

风湿性心脏病二尖瓣成形中功能性三尖瓣反流的外科治疗

风湿性心脏病联合瓣膜病变中合并功能性三尖瓣反流者占２２％～３５％，目前认为对于其中中度反流以上的应同期行三尖瓣矫治［１］。我们报告我院在二尖瓣成形术中对功能性三尖瓣反流的ＤｅＶｅｇａ成形术。１　临床资料与方法我院从１９８９年１１月～１９９５年１２月共行二尖瓣成形１９３例，合并三尖瓣反流者８４例，同时行功能性三尖瓣反流矫治４１例。男１７例，女２４例；年龄１７～５０岁，平均３３±８－１１岁。术前诊断二尖瓣狭窄１２例，二尖瓣关闭不全７例，二尖瓣狭窄并关闭不全２２例。术前三尖瓣反流的体征：颈静脉怒张３５…     

二尖瓣反流患者经心尖二尖瓣夹合术的护理配合

总结经心尖二尖瓣夹合术治疗1例二尖瓣反流患者手术护理配合要点。提出术前落实完善各项准备、联合多学科团队共同探讨可能的突发状况并制定预案;术中熟练使用各种仪器设备,为术者提供动态信息,掌握术中护理配合要点步骤,以保证二尖瓣夹合术顺利实施。     

心肌梗死后室壁瘤及二尖瓣反流的外科治疗

目的 总结心肌梗死后室壁瘤和二尖瓣反流的外科治疗经验,以提高手术疗效和生存率.方法 回顾性分析2000年12月～2007年6月间收治的37例心肌梗死后室壁瘤及中度以上二尖瓣反流患者的临床资料,大多数患者行冠状动脉旁路移植术加室壁瘤切除后左心室重建、二尖瓣成形或置换术.结果 术后死亡3例,死亡率8.1%,其中死于肾功能衰竭2例,脑部并发症1例.随访30例,随访率88.2%(30/34),4例失访;随访时间1个月至6年.随访期间死亡2例,其中1例死于抗凝治疗失败并发的大面积脑梗死,1例死于肺部感染和心力衰竭.术后6个月复查心脏彩色超声心动图提示:左心房内径较术前明显缩小(30.1±3.5mm vs.39.3±3.7mm, P=0.004),左心室舒张期末内径较术前明显缩小(48.4±4.3mm vs.61.2±5.1mm, P=0.003),旷置的室壁瘤大小无明显变化(直径＜5 cm),二尖瓣成形和旷置者无反流或轻微反流12例,轻度反流2例,中度反流1例.结论 对不同类型的心肌梗死后室壁瘤和二尖瓣反流患者制定相应的手术治疗方案,能取得良好的近、远期疗效,绝大部分患者心功能改善明显,生存率提高.     

中国二尖瓣反流患者人群数量的估测

二尖瓣反流(mitral regurgitation,MR)是最常见的心脏瓣膜疾病.近年来,介入治疗的兴起扩大了MR患者的手术治疗指征,但我国MR流行病学(特别是需要治疗的MR数量)特征尚不明确.本文借鉴欧美3项基于社区人群的流行病学研究,参考国内复旦大学附属中山医院、浙江大学医学院附属第二医院、北京阜外医院基于医院患...     

The outcome and criteria for mitral valve surgery in patients with ischemic mitral regurgitation

Objectives: Mitral valve surgery for the correction of mitral regurgitation (MR) in patients with ischemic heart disease has been associated with poor prognosis. The criteria for selecting an appropriate surgical procedure are not clearly defined. The objectives of this study were to clarify the criteria for mitral valve manipulation and the outcome in patients with ischemic MR.Methods: Twenty patients with ischemic MR were proposed for surgery. Ten of them (group A) had grade II MR and underwent isolated coronary artery bypass grafting (CABG). The remaining 10 patients with grade III or more MR underwent both CABG and mitral valve repair (group B). Postoperative left ventricular function and outcome were compared.Results: Preoperative left ventricular end-systolic volume index (LVESVI) in group A was significantly smaller, while preoperative ejection fraction (EF) was almost equal between the groups. EF demonstrated a significant improvement in group A postoperatively, but no changes in group B. Two of group B died following surgery. The other patients were successfully treated with surgery which diminished MR. Congestive heart failure (CHF) developed in 2 patients of group B during follow-up and in none of group A. The 5-year freedom from CHF and the 5-year survival rate in group A were significantly greater than those in group B.Conclusions: Deterioration of mitral valve function, which necessitated mitral valve repair, was more frequent in the impaired and enlarged hearts. Although mitral repair was beneficial for diminishing MR and New York Heart Association, postoperative course in patients with ischemic MR depended on the preoperative LVESVI.     

Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation

Background

The management of severe mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation is controversial. We adopted an approach of systematic repair of severe MR at the time of LVAD implantation and report our experience.

Late results of mitral valve repair for mitral regurgitation

OBJECTIVE: This study was undertaken to evaluate the long-term results of mitral valve repair for mitral regurgitation. METHODS: Between 1991 and 2000, 301 patients with mitral regurgitation underwent mitral valve repair. There were 167 men and 134 women whose mean age was 56 +/- 14 years. The patients were comprised of 7 patients in Carpentier's type I, 277 patients in type II, and 17 patients in type III. Chordal replacement with expanded polytetrafluoroethylene sutures had been prospectively applied to repair the anterior mitral leaflet prolapse. Ring annuloplasty was performed in 230 patients (76%). The follow-up was complete and mean follow-up was 67 +/- 33 months, for a cumulative follow-up of 1,624 patient-years. RESULTS: There were 5 hospital deaths and 11 late deaths (2 cardiac and 9 noncardiac). All survivors except those with stroke were in the New York Heart Association (NYHA) functional class I or II. At 10 years, the actuarial survival was 90 +/- 3%, the freedom from embolism was 86 +/- 4%, the freedom from reoperation was 96 +/- 2%, and the freedom from valve-related events was 77 +/- 4%. At 10 years, the freedom from reoperation in the patients with anterior leaflet prolapse was 90 +/- 5%. CONCLUSIONS: Mitral valve repair is feasible in most patients with mitral regurgitation and is associated with low mortality and low rates of valve related events. Chordal replacement with expanded polytetrafluoroethylene sutures is effective, safe, and durable at long-term follow-up for patients with anterior leaflet prolapse.     

Late results of mitral valve repair for mitral regurgitation

Objective: This study was undertaken to evaluate the long-term results of mitral valve repair for mitral regurgitation.Methods: Between 1991 and 2000, 301 patients with mitral regurgitation underwent mitral valve repair. There were 167 men and 134 women whose mean age was 56±14 years. The patients were comprised of 7 patients in Carpentier's type I, 277 patients in type II, and 17 patients in type III. Chordal replacement with expanded polytetrafluoroethylene sutures had been prospectively applied to repair the anterior mitral leaflet prolapse. Ring annuloplasty was performed in 230 patients (76%). The follow-up was complete and mean follow-up was 67±33 months, for a cumulative follow-up of 1,624 patient-years.Results: There were 5 hospital deaths and 11 late deaths (2 cardiac and 9 noncardiac). All survivors except those with stroke were in the New York Heart Association (NYHA) functional class I or II. At 10 years, the actuarial survival was 90±3%, the freedom from embolism was 86±4%, the freedom from reoperation was 96±2%, and the freedom from valve-related events was 77±4%. At 10 years, the freedom from reoperation in the patients with anterior leaflet prolapse was 90±5%.Conclusions: Mitral valve repair is feasible in most patients with mitral regurgitation and is associated with low mortality and low rates of valve related events. Chordal replacement with expanded polytetrafluoroethylene sutures is effective, safe, and durable at long-term follow-up for patients with anterior leaflet prolapse. Read at the Fifty-fifth Annual Meeting of The Japanese Association for Thoracic Surgery, Symposium, Fukuoka, October 9–11, 2002.     

Ischemic mitral valve repair: Correlations between the mechanisms of mitral regurgitation and left ventricular function prior to and following surgery

Objective.?To define the mechanisms of ischemic mitral regurgitation (MR) and its correlation with left ventricular (LV) function prior to and 1 year following mitral valve (MV) repair. Design.?Fifty-three patients (pts) underwent echocardiographic evaluation of the MR mechanism according to Carpentier's classification; quantification of MR and LV function. Results.?Forty-one, 5% of pts had Type I (annulus dilation), 20, 5% had Type II (commissural prolapse) and 38% had Type IIIb MR (predominant posterior leaflet restriction). Preoperative LV function was slightly better preserved in pts with Type II and IIIb MR. Despite similar MV repair efficiency intraoperatively, after 1 year Type I MR progressed vs the remaining types. LV function, including dimensions, ejection fraction and pulmonary artery pressure had a tendency to worsen in pts with Type I and markedly improved in Type II and IIIb MR. Conclusions.?Ischemic MR of Type I is associated with more marked LV dysfunction preoperatively, its further deterioration and MR progression after MV repair. Type II and IIIb MR correlates with better preserved LV function preoperatively and its incremental improvement late after surgery.     

Concomitant mitral valve repair and left ventricular reconstruction in a patient with chronic ischemic mitral regurgitation and inferior left ventricular aneurysm

The surgical approach to ischemic mitral regurgitation with concomitant inferior left ventricular aneurysm remains uncertain in terms of the indication for operation and the short-and long-term outcomes. We performed concomitant mitral valve repair, left ventricular reconstruction, and aortic valve replacement on a 71-year-old male with severe ischemic mitral regurgitation, inferior left ventricular aneurysm, and degenerative aortic regurgitation. Postoperative status was in New York Heart Association functional class I without mitral regurgitation 8 months after operation. We discuss, and review the procedures reported in the literature.     

Successful mitral valve repair for isolated mitral regurgitation in a child with Williams syndrome

Williams syndrome is a genetic disorder associated with various cardiovascular abnormalities, most commonly supravalvar aortic stenosis and peripheral pulmonary stenosis. However, isolated severe mitral regurgitation necessitating surgical intervention is extremely rare. Here, we present the case of a 14‐year‐old child with Williams syndrome and isolated severe mitral regurgitation who underwent successful mitral valve repair.