ePTFE人工腱索二尖瓣成形术

本文介绍了用ePTFE缝线作人工腱索行二尖瓣成形术 14例的体会。 14例中用ePTFE缝线作人工腱索 17根 ,二尖瓣成形主要有四种方法 :瓣叶部分切除、切缘缝合 ,然后再在瓣缘和乳头肌间建立人工腱索。二尖瓣裂隙伴卷曲瓣叶的人工腱索重建。大瓣部分切除、自体心包片修补瓣叶后 ,人工腱索重建。瓣叶矩形切除、瓣环Kay成形术。结果 ,因持续性Hb尿再次手术行二尖瓣置换和晚期死亡各 1例 ,其余患者术后恢复满意。作者认为只要正确选择病例 ,用ePTFE缝线作人工腱索行二尖瓣成形术是安全有效的     

预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂

目的:回顾预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂,探讨此手术对二尖瓣脱垂的治疗效果。方法:2008年1月至2012年12月间,回顾性分析北京安贞医院收治的15例二尖瓣脱垂患者,其中男性10例,女性5例,年龄(48.5±3.2)岁,SBE后腱索断裂导致关闭不全2例,单纯腱索断裂导致关闭不全8例,腱索延长导致关闭不全5例。术前超声心动图(TEE)显示:根据Carpentier标准,前叶脱垂10例,后叶脱垂3例,前叶合并后叶脱垂2例。所有患者二尖瓣均为重度关闭不全,反流面积(11.0±0.9)cm2,1例合并三尖瓣重度反流。术前射血分数(EF)平均(64.9±1.9)%,左心室舒张末直径(LVDD)平均(54.9±1.4)mm,左心房直径(LA)平均(42.9±1.7)mm。所有患者均经胸正中切口,体外循环下行预制人工腱索环移植,移植腱索数量为(3.6±0.3)根,腱索长度(15.4±1.5)mm,平均体外循环时间(113±11.7)min,平均主动脉阻断时间(86±9.8)min。3例患者置入SJ成形环,12例患者置入爱德华成形环,1例患者同时行三尖瓣成形术。结果:术后无死亡,无恶性心律失常及其他严重并发症。术后复查TEE显示少量反流3例,微量反流8例,未见反流4例。术后EF平均(60.2±2.9)%,未见明显改变。LVDD平均(46.5±1.1)mm,LA平均(32.9±1.2)mm,均较术前明显改善。随访12~57个月,平均(35.7±4.3)个月,少量反流3例,无或微量反流12例。结论:预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂近中期效果确切,但是远期预后尚需进一步观察。     

瓣叶切除与人工腱索治疗单纯二尖瓣后叶脱垂的病例对照研究

目的 比较单纯二尖瓣后叶脱垂应用瓣叶切除或人工腱索技术行二尖瓣成形术的手术效果。 方法 2010年12月至2013年12月, 384例患者病因单纯二尖瓣后叶脱垂导致的二尖瓣反流于我科行二尖瓣成形术,其中单纯人工腱索者33例（8.6%）、单纯瓣叶切除者258例（67.2%）。应用倾向评分匹配进行配对,分为人工腱索组（n=32）与瓣叶切除组（n=32）,并进行比较。回顾性分析两组围手术期情况及术后随访结果。结果 倾向评分匹配后人工腱索组和瓣叶切除组的各项术前指标无统计学差异。两组均顺利完成手术,无围手术期死亡。两组体外循环时间、主动脉阻断时间均有统计学差异（P=0.009、0.013）。人工腱索组使用较大二尖瓣成形环更多（P=0.019）。两组出院前左室射血分数（LVEF）、舒张期二尖瓣跨瓣峰值压差（TMG）均无统计学差异。平均随访（31.8±11.9）个月,两组患者生存、再次手术、≥中度二尖瓣反流、舒张期二尖瓣跨瓣峰值压差、再次手术均无统计学差异,但人工腱索组LVEF为（66.0±4.1）%,瓣叶切除组LVEF为（61.5±5.9）%,两组间有统计学差异（P=0.007）。 结论 人工腱索技术和瓣叶切除技术都可以有效地修复二尖瓣后叶脱垂。人工腱索技术与瓣叶切除技术相比更有利于术后左室功能,但两种技术在术后生存及二尖瓣反流情况上并无差异。     

人工腱索移植术治疗二尖瓣前叶脱垂

用ePTFE缝线作人工腱索行二尖瓣成形术8例,共做人工腱索21根,同期行冠状动脉搭桥2例、房间隔缺损修补1例、三尖瓣成形3例.术后1例出现二尖瓣中度反流,再次转机,加用edge to edge技术后,食管超声复查示轻度反流,其余患者无二尖瓣反流或轻微、轻度反流.随访1～30个月,二尖瓣反流均无明显加重.认为ePTFE作为人工腱索治疗二尖瓣前叶脱垂效果可靠,术中准确确定人工腱索的长度是关键,术中食管超声心动图检查可确定手术效果.     

复杂二尖瓣前叶脱垂不同术式选择探讨

目的:总结腱索转移、人工腱索、瓣叶折叠及双孔技术在二尖瓣成形术中的临床应用和体会,提高临床治疗效果。方法:回顾性分析2007年1月至2013年8月,采用四种成形技术治疗的以二尖瓣前叶脱垂为主病例122例,其中男性68例,女性54例,年龄18~69岁,平均(43±7.9)岁,A1区脱垂21例,A2区脱垂12例,A3区脱垂28例,A1合并A2区脱垂26例,A2合并A3区脱垂35例,合并后叶脱垂16例。术前心功能分级(NYHA分级)Ⅱ级67例,Ⅲ级55例。45例采用腱索转移技术,54例采用人工腱索技术,12例采用瓣叶折叠技术,11例采用双孔技术,5例合并冠心病同期行冠状动脉旁路移植术(前降支单支桥3例,回旋支单支桥2例,)。结果:腱索转移组和人工腱索组均无围手术期死亡,瓣叶折叠组1例患者术后第8天死于多脏器功能衰竭,双孔技术组1例患者术后13 d死于肺部感染。出院前心脏超声显示:腱索转移组少量反流6例,微量反流14例,未见明显反流25例。人工腱索组少量反流16例,微量反流15例,未见明显反流23例。瓣叶折叠组少量反流8例,微量反流4例。双孔技术组少量反流9例,微量反流2例。四组术前、出院前、术后6个月左心室射血分数、左心室舒张末内径、收缩末内径差异无统计学意义(P0.05)。四组术前舒张末内径、收缩末内径较出院前、术后6个月舒张末内径、收缩末内径差异有统计学意义(P0.05)。四组出院前射血分数较术前、术后6个月低,差异有统计学意义(P0.05)。腱索转移组术后14个月1例患者因转移的腱索缝合缘撕脱造成二尖瓣大量反流再次手术置换二尖瓣。人工腱索组1例患者术后6个月频繁出现血红蛋白尿再次手术置换二尖瓣。结论:四种成形技术可以满足各种类型复杂二尖瓣前叶脱垂的处理。腱索转移适合单纯的前叶脱垂病变;人工腱索适用范围更广泛,容易学习;瓣叶折叠适用范围稍窄,适合初学者;双孔技术适用范围较广,不应作为首选方法,可和其他方法联合应用。四种方法均有良好的近期效果,值得去掌握和应用。     

“缘对缘”技术防治二尖瓣成形术后收缩期前向运动及中远期随访结果

目的 研究应用“缘对缘”技术防治二尖瓣成形术后收缩期前向运动(Systolic anterior motion, SAM)的疗效及中远期随访结果。 方法 回顾性总结分析2006年1月至2015年12月我院应用“缘对缘”技术防治二尖瓣成形术后SAM的41例患者的临床资料,其中男25例、女16例,年龄32～68(52.6±15.8)岁。二尖瓣成形手术技术包括后瓣叶矩形切除、人工腱索移植、采用成形环行瓣环成形等。对于术前诊断有SAM和术中发现有SAM高危因素的患者归入预防组(n=32),对于术中二尖瓣成形后TEE检查发现有SAM经非手术处理无法纠正的患者归入治疗组(n=9)。在原有二尖瓣成形方法的基础上,应用4-0或5-0聚丙烯线于二尖瓣A2和P2相对应部分采用“8”字缝合方法,瓣叶上的缝合部位位于瓣叶对合线下方。 结果 全组患者均成功完成二尖瓣成形术。所有病例均应用了二尖瓣成形环,采用“C”形环,成形环大小为26～32(29.2±2.8)mm。无手术死亡。术后2例轻度SAM,二尖瓣反流(mitral regurgitation, MR)和左室流出道(left ventricular outflow tract, LVOT)狭窄均为轻度。二尖瓣口平均跨瓣压差从0.3±0.4mmHg上升到2.2±1.5mmHg(P>0.05)。MR程度从术前的3.5±0.9减少至0.7±0.6(P<0.001)。术后早期有2例出现轻中度MR。术后随访48.4±23.5个月。随访中无新出现SAM,2例中度MR,无中度以上MR。无MR或SAM需要再手术。5年免于再手术率100%。 结论 应用“缘对缘”技术防治二尖瓣成形术后SAM安全、简便、有效,中远期随访疗效良好。     

38例二尖瓣成形术临床分析

目的总结38例二尖瓣成形术的临床经验.方法实施二尖瓣成形术38例,其中,后叶矩形切除9例,"双孔法"13例,后叶腱索转移3例,后叶矩形切除 "双孔法"2例,后叶腱索转移 "双孔法"3例,前、后交界环缩2例,单纯放人工瓣环4例,瓣叶穿孔修补2例.本组35例植入人工瓣环.结果术后经食管超声心动图(TEE)检查二尖瓣反流消失或微量反流32例,少量反流6例.1例术后第一天发生瓣膜撕裂,行二尖瓣替换术后痊愈.1例术后第九天因消化道出血,继发肾功能衰竭死亡.36例术后早期超声复查,二尖瓣舒张期流速0～1.9m/s,平均(1.23±0.39)m/s.跨瓣压差0～14.4mmHg,平均(6.61±3.56)mmHg.36例随访2～70个月,心功能Ⅰ级31例,Ⅱ级5例.结论对于二尖瓣关闭不全的患者,术中准确判断二尖瓣的病变,采用相应的成形技术,可以取得良好的早、中期治疗效果.     

“缘对缘”联合人工瓣环修复术治疗二尖瓣关闭不全42例分析

【】 目的 探讨“缘对缘”联合人工瓣环修复二尖瓣成形术治疗二尖瓣关闭不全的手术效果。方法 回顾性分析2004年1月至2008年12月对42例非风湿性二尖瓣关闭不全患者行“缘对缘”联合人工瓣环修复二尖瓣成形术的临床资料,男25例,女17例;年龄12～69岁(36.42±14.28岁),其中先天性二尖瓣病变12例,瓣膜退行性病变20例,缺血性二尖瓣关闭不全7例,感染性心内膜炎3例。术前心脏彩超提示：前叶病变27例,前叶 后叶病变17例;二尖瓣重度反流19例,中度至重度14例,中度反流9例;42例患者均在全身麻醉低温体外循环下应用“缘对缘”联合人工瓣环修复术进行二尖瓣成形术。术中应用250mL注射器向左心室注冰盐水观察评价成形后二尖瓣反流情况,脱离体外循环后经食管超声心动图观察成形结果。分别测量术前及术后二尖瓣反流面积、二尖瓣开口面积、左房内径及左室舒张末期内径,左室射血分数,应用t检验,研究手术前后二尖瓣反流、心脏大小变化、心功能改善情况。检验水准α=0.05。结果 全组无死亡病例,出院时心脏功能(NYHA分级)I级32例,Ⅱ级10例。随访39例,随访时间1-60(24.6±18.2)个月。超声心动图提示：术前二尖瓣反流面积为11.0cm₂±3.8cm₂,术后1年无或微量反流13例,轻度反流17例,轻度至中度反流9例,轻度二尖瓣狭窄1例,反流面积为4.1cm₂±1.4cm₂;术前二尖瓣开口面积4.14 cm₂±1.54cm₂,术后一年为3.58 cm₂±1.10cm₂;术前左心房内径为48.6mm±12.4mm,术后1年为36.5 mm±9.4mm;术前左心室舒张末径为64.3 mm±11.4mm,术后1年为50.6 mm±7.6mm;术前左心室射血分数为54.6%±6.2％,术后1年提高为63.4%±4.0％。结论“缘对缘”联合人工瓣环修复二尖瓣成形术治疗二尖瓣关闭不全手术方法安全、有效,可获得良好的治疗效果。     

多技术综合运用治疗复杂二尖瓣关闭不全13例

目的 总结多技术综合运用治疗复杂二尖瓣关闭不全的临床经验.方法 13例二尖瓣关闭不全且均存在2个以上反流点患者,其中男性9例,女性4例,年龄15～73 岁.病因分别为二尖瓣腱索断裂5例,二尖瓣黏液变性伴瓣叶脱垂6例,先心病继发房缺1例,冠心病伴二尖瓣乳头肌功能不全1例.二尖瓣反流程度中度4例、重度9例.术中联合应用二孔化成形、后瓣矩形切除、腱索转移、腱索缩短、人工腱索置入、人工瓣环置入等技术修补二尖瓣使其恢复功能.结果 本组无住院死亡病例,术后1周心脏彩超复查示二尖瓣无任何反流或微量反流8例,轻度返流5例,随访的患者中1例术后9个月二尖瓣由微量反流增加至中度反流,并患急性重症肝炎死亡.其余患者随访情况良好,心功能明显改善.结论 合理综合应用二孔化成形、人工腱索等多种技术治疗复杂多区域二尖瓣反流,近、中期疗效满意.     

成人再次二尖瓣成形术的临床特征分析

目的分析二尖瓣成形术后复发性病变的病因,总结再次二尖瓣成形术的手术技术和效果。方法回顾分析2012年1月至2019年10月阜外医院19例行再次二尖瓣成形术的成人患者的临床资料,男12例,女7例,首次手术年龄4~66岁,平均(34.9±22.6)岁。先天性二尖瓣关闭不全7例,退行性二尖瓣关闭不全12例。再次手术时年龄18~81岁,平均(43.5±19.1)岁。两次手术间隔2~430个月,平均(118±116)个月。再次手术同期进行三尖瓣成形术5例,冠状动脉搭桥手术2例,左房血栓清除1例。术前心胸比0.56±0.07,左房内径(LA)为(49.4±8.5)mm,左室舒张末径(LV)为(56.6±5.9)mm,左室射血分数(LVEF)62.6%±7.8%。结果手术失败组包括瓣叶缝线撕脱5例,瓣叶裂未完全缝合2例、人工瓣环瓣周漏2例、人工腱索撕脱1例。病变进展或新发病变组包括新发瓣叶脱垂4例,瓣环明显扩张2例,自体腱索断裂1例,感染性心内膜炎1例,二尖瓣相对性狭窄1例。本组患者体外循环时间(109±53)min,阻断时间(70±29)min,术后呼吸机使用时间(16±5.8)h。围术期无死亡。出院时有2例二尖瓣少中量反流,LA为(42.9±6.1)mm,LV为(53.4±6.3)mm,LVEF为59.3%±3.8%。术后随访(21.0±14.9)个月。1例术后2个月出现感染性心内膜炎,二尖瓣中量反流。另有1例术后10个月发生脑梗死。无死亡、再次手术患者,心功能均为Ⅰ级或Ⅱ级。结论二尖瓣成形术后出现复发性二尖瓣病变患者,在瓣叶条件良好,反流原因明确情况下,行再次二尖瓣成形手术可以获得满意的围术期结果,近中期疗效良好。     

Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation.

AIMS: We present 5-year echocardiographic results of combined undersizing mitral ring annuloplasty (UMRA) and coronary artery bypass grafting (CABG) in chronic ischaemic mitral regurgitation (CIMR). METHODS AND RESULTS: Two hundred and fifty-one patients (aged 68.4 +/- 8.1, 62.5% male) undergoing combined CABG and UMRA in our Institution (Cardiac Surgery, Careggi Hospital, Florence, Italy) between September 2001 and March 2007 were prospectively enrolled in the study. Median follow up was 32.9 months [interquartile range (IQR) 17.5-51.6]. Fourteen patients with significant residual mitral regurgitation (MR) needing immediate intraoperative revision (n = 3) or at discharge (n = 11) were excluded from the study. Serial echocardiograms were performed in 220 survivors at baseline, discharge, and annually thereafter. Additionally, 17 patients died (2 early and 15 late deaths) and were also excluded from the study. MR remained stable at 1 year and re-increased at 3 years (P < 0.001) and 5 years (P < 0.001). Five-year actuarial survival was 83.2 +/- 4.4. Five-year freedom from re-operation for failed repair was 78.2 +/- 4.9%. Mean systolic and diastolic diameters decreased significantly at discharge (P = 0.001 and P = 0.01, respectively) and at early follow up (P = 0.004 and P = 0.02) but raised at 3 years (P < 0.001) and 5 years (P < 0.001). Systolic and diastolic sphericity indexes improved at discharge (P < 0.001) remained stable at 1 year but they re-increased at 3-year control (P = 0.006 and P = 0.03, respectively) with a late raise exceeding the pre-operative value (P < 0.001). Left ventricular reverse remodelling was observed in 44.2% of the study population with 10.3% of patients showing further left ventricular dilatation. At multivariable model, end-systolic volume > or =145 mL, systolic sphericity index > or =0.7, myocardial performance index > or =0.9, and wall motion score index > or =1.5 were predictors of recurrent MR. CONCLUSION: Our findings emphasize the need for improved repair technique and better patient selection to identify patients with anticipated repair failure who could benefit more from valve replacement or other procedure directly addressing ventricular tethering.     

Echocardiography of the Mitral Valve

Echocardiography is the primary imaging modality for assessment of the mitral valve (MV). It provides an accurate and non-invasive tool to assess the morphology, geometry and function of the MV apparatus, which form the basis of the mechanisms and classification of MV disease. This review highlights the mechanistic insights into MV dysfunction by echocardiography and the critical role of echocardiography in the quantitative assessment of the severity of mitral regurgitation and mitral stenosis.     

Isolated cleft posterior mitral valve leaflet: an uncommon cause of mitral regurgitation

A 53-year-old woman with a history of hypertension was referredfor an echocardiogram by her primary care physician after anunspecified abnormal ECG. The echocardiogram showed normal leftventricular size and function; however, an isolated cleft posteriormitral valve leaflet was identified with concomitant bileafletprolapse and mild mitral regurgitation. She was subsequentlyreferred to a cardiologist for clinical evaluation. Cleft mitralvalve leaflet (CMVL) is an uncommon congenital cause of mitralregurgitation. Clefts, defined as slit-like holes or defects,are hypothesized to be a result of incomplete expression ofan endocardial cushion defect which most commonly involves theanterior mitral valve leaflet with a paediatric incidence of1:1340. Clefts affecting only the posterior mitral valve leafletare extremely rare with only four cases being reported in themedical literature. Important co-existing anomalies with eitherposterior and/or anterior CMVL include counterclockwise rotationof the papillary muscles, the presence of an accessory papillarymuscle or mitral valve leaflet, atrial septal defects, and mitralvalve prolapse. Regurgitation from CMVL can lead to importantphysiological and anatomical changes within the cardiac system.Regurgitation results from blood flow directly through the cleftitself or from malcoaptation from accessory chordae with orwithout papillary muscle distortion. Significant chronic mitralregurgitation elevates left atrial filling pressures and leadsto chamber enlargement and eccentric left ventricular hypertrophy.Early detection through two-dimensional echocardiography canprovide accurate anatomical images of the various mitral valvestructures and identify associated congenital anomalies. Earlysurgical correction is preferred before mitral regurgitationcauses unfavourable remodelling. Most mitral valve cleft defectscan easily be repaired by suturing the edges of the cleft. Ifa cleft resection leads to limited residual valve tissue, theleaflet of the mitral valve can be reconstructed using an autologouspericardial patch pre-treated with buffered glutaraldehyde.Posterior CMVL is an uncommon but clinically important causeof mitral insufficiency. Early recognition of this rare clinicalentity and possible co-existent anomalies can identify the patientswho would benefit from surgical intervention before compensatoryleft ventricular remodelling and contractile dysfunction develop.     

Mitral stenosis after Duran ring annuloplasty for non-rheumatic mitral regurgitation--a foreign body response?

We report two cases of mitral stenosis after Duran ring annuloplasty for myxomatous mitral regurgitation. Simple explantation of the ring provided relief of mitral stenosis.     

Mitral valve repair for severe mitral regurgitation: the way forward?

Severe primary mitral regurgitation (MR) has a poor outcome if left uncorrected. Successful mitral valve repair has the unique potential to restore normal life expectancy and is superior to valve replacement. Despite this, mitral repair is performed relatively infrequently and many patients with potentially reparable valves have a replacement instead, subjecting them to unnecessary risk. Surgery in asymptomatic patients is a particularly difficult issue with some units advocating surgery irrespective of symptoms, based purely on the severity of regurgitation. This strategy cannot be widely adopted with the current patchy provision of high-quality valve repair surgery. Misplaced enthusiasm for early operation runs the risk of a failed repair and the hazards of a mechanical prosthesis. To ensure optimal treatment for patients with MR, cardiologists must be aware of the indications for valve repair and ensure that patients with potentially reparable valves are referred to surgeons with proven expertise, even if this means a shift from established practice. Surgical units need to promote subspecialization and rigorously audit their outcomes. There are currently no agreed standards for best practice in mitral valve repair and this is an area where professional societies may wish to take a role.     

Three-dimensional echocardiography in mitral valve disease.

Three-dimensional echocardiography offers great promise for improving the understanding of the mitral valve anatomy, function, and pathology. It may have important implications for medical or surgical management of different mitral valve disease. In this article we provide an overview of the three-dimensional anatomy of the mitral valve. Based on the studies using three-dimensional echocardiography we describe the topography of the mitral valve, its nonplanarity as well as dynamics of the mitral annulus. Furthermore, we review the use of three-dimensional echocardiography in the evaluation of different mitral valve disease. Three-dimensional echocardiography has become a new clinical standard in the assessment of the severity of mitral stenosis by means of accurate mitral valve area measurement. Also, unconventional indices, like the geometry and mitral valve volume may be assessed by three-dimensional echocardiography. It is a very suitable technique for monitoring the efficacy and complications of percutaneous mitral valvuloplasty. Three-dimensional echocardiography allows accurate identification and quantification of prolapse of individual segments of the mitral valve leaflets. Three-dimensional color flow imaging makes echocardiography an accurate method also in the assessment of mitral regurgitation severity. Finally, we outline three-dimensional echocardiography as a potentially useful guide for a surgeon, particularly in mitral valve repair.     

New techniques for percutaneous repair of the mitral valve

A variety of innovative techniques and devices are being developed for the percutaneous management of mitral insufficiency. More than 30 devices are in stages of development from early stage to human pivotal trials. Two devices for the management of degenerative myxomatous disease of the mitral valve replicate the Alfieri edge-to-edge surgical repair. One of those devices, the Evalve Mitraclip, is in a pivotal trial at the current time. The other devices address functional mitral regurgitation by a variety of techniques for performing mitral valve annuloplasty. The majority of devices take advantage of the proximity of the coronary sinus to the posterior mitral annulus to deliver devices that remodel the mitral annulus. Two devices perform septal lateral cinching decreasing the anterior posterior diameter of the mitral annulus and correcting leaflet malcoaptation. Numerous issues are discussed including regulatory hurdles and the integration of percutaneous techniques into clinical practice in a safe and efficacious manner.     

Mitral balloon valvotomy,long-term results,its impact on severe pulmonary hypertension,severe tricuspid regurgitation,atrial fibrillation,left atrial size,left ventricular function

Percutaneous mitral balloon valvotomy (MBV) was introduced in 1984 by Inoue who developed the procedure as a logical extension of surgical closed commissurotomy. Since then, MBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis (MS). With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of complications declined. When the reported complications of MBV are viewed in aggregate, complications occur at approximately the following rates: mortality (0–0.5%), cerebral accident (1–2%), mitral regurgitation (MR) requiring surgery (0.9–2%). These complication rates compare favorably to those reported after surgical commissurotomy. Several randomized trials reported similar hemodynamic results with MBV and surgical commissurotomy. Restenosis after MBV ranges from 4% to 70% depending on the patient selection, valve morphology, and duration of follow-up. Restenosis was encountered in 31% of the author’s series at mean follow-up of 9 ± 5.2 years (range 1.5–19 years) and the 10, 15, and 19 years restenosis-free survival rates were (78 ± 2%) (52 ± 3%) and (26 ± 4%), respectively, and were significantly higher for patients with favorable mitral morphology (MES ⩽ 8) at 88 ± 2%, 67 ± 4% and 40 ± 6%, respectively (P < 0.0001). The 10, 15, and 19 years event-free survival rates were 88 ± 2%, 60 ± 4% and 28 ± 7%, respectively, and were significantly higher for patients with favorable mitral morphology 92 ± 2%, 70 ± 4% and 42 ± 7%, respectively (P < 0.0001). The effect of MBV on severe pulmonary hypertension, concomitant severe tricuspid regurgitation, left ventricular function, left atrial size, and atrial fibrillation is addressed in this review.     

经皮穿刺二尖瓣球囊成形术200例报告

本文对１９８８年５月至１９９２年７月间以Ｉｎｏｕｅ单球囊瓣膜成形术治疗二尖瓣狭窄２００例进行分析。本组中男６３例，女１３７例，平均年龄３６．５±８．８岁。经血液动力学及左室造影观察，取得良好效果。左房平均压自３．３４±１．２２ｋＰａ（２５．０８±９．１３ｍｍＨｇ）下降至１．４２±０．５５ｋＰａ（１０．６４±４．１０ｍｍＨｇ）（Ｐ＜０．００１）；二尖瓣跨瓣压差由３．４０±１．３６ｋＰａ（２５．４９±１０．２２ｍｍＨｇ）下降为０．８９±０．６５ｋＰａ（６．７１±４．８７ｍｍＨｇ），肺动脉收缩压由７．０４±２．８６ｋＰａ（５２．７８±２１．４２ｍｍＨｇ）下降为５．１４±２．２０ｋＰａ（３８．５６±１６．４７ｍｍＨｇ）（Ｐ＜０．００１）；心输出量由３．８４±０．１１Ｌ／ｍｉｎ上升为４．６６±０．２８Ｌ／ｍｉｎ（Ｐ＜０．００１）；二尖瓣口面积由１．０８±０．２８ｃｍ２增大为２．２０±０．４７ｃｍ２（Ｐ＜０．００１）。５０例随访６～４８个月（平均２４个月），临床症状改善率为１００％。本文对经皮穿刺二尖瓣球囊成形术（ＰＢＭＶ）适应证、方法、效果、并发症及其作用机制进行了讨论。     

二尖瓣成形术367例分析

目的:总结367例二尖瓣成形术的临床经验,评价二尖瓣成形术的临床效果.方法:回顾性分析我院1996-10～2006-12进行二尖瓣成形术的7岁以上患者367例,其中瓣膜退行性病变295例;先天性二尖瓣病变26例;缺血性改变导致二尖瓣关闭不全20例;风湿性心脏病18例;感染性心内膜炎8例.术前纽约心功能NYHA分级Ⅱ级193例,Ⅲ级156例,Ⅳ级18例,术前超声心动图显示二尖瓣反流量轻一中度25例,中度109例,中到重度134例,重度99例;左心房内径24～71(45.10±9.13)mm,左心室舒张期末内径30～86(60.13±7.89)mm.均在低温体外循环下行二尖瓣成形术.结果:术中经打水实验或食道超声心动图评价成形效果满意,术后1周复查超声心动图示左心房内径14～83(34.99±8.30)mm,左心室舒张期末内径31～71(50.64±6.54)mm,与术前相比明显缩小,差异有统计学意义(P均＜0.001).术后早期死亡1例;331例患者随访3个月至11年,心功能NYHA分级Ⅰ级患者280例,Ⅱ级41例,Ⅲ级4例,Ⅳ级6例;超声心动图示左心房内径21～73(39.11±9.33)mm,左心室舒张期末内径34～79(50.04±6.51)mm,与术前相比明显缩小,差异有统计学意义(P均＜0.001).192例患者二尖瓣无或微量反流,97例少量反流,27例少到中量反流,7例中量反流,2例中到大量反流,6例大量反流.4例术后行二尖瓣置换术,1例发生溶血,晚期死亡4例.结论:根据二尖瓣病变的特征进行选择,采用相应的成形技术,对非风湿性二尖瓣病变行尖瓣成形术可取得较满意的临床效果.术中行食道超声心动图和注水实验能为判断手术效果提供有益的帮助.