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1.
目的:探讨缺血性二尖瓣关闭不全(IMR)老年患者选用冠状动脉旁路移植(CABG)同时行二尖瓣生物瓣置换(MVR)(BV)与CABG行二尖瓣成形(MVP)的早、中期临床效果差异。方法:选取我院2011-06-2017-06因IMR行CABG+MVR(BV)或CABG+MVP的老年患者59例,比较其围手术期超声心动图指标及术后第1、2、3、4、5年随访资料。终点事件为术后死亡、再次行二尖瓣手术、术后出现心力衰竭和二尖瓣重度反流。结果:CABG+MVP(BV)组与CABG+MVP组在体外循环时间、升主动脉主动阻断时间、心力衰竭及死亡事件发生率方面差异无统计学意义。CABG+MVP(BV)组术后重度反流发生率明显低于CABG+MVP组(P0.05)。CABG+MVP(BV)组与CABG+MVP组手术前后LVEF均无明显差异,术后左心房内径(LAD)与左心室舒张末内径(LVEDD)均较术前明显降低(均P0.05)。CABG+MVP(BV)组平均生存时间为41.5个月,CABG+MVP组平均生存时间为42.8个月。两组长期生存率差异无统计学意义。结论:CABG+MVR(BV)与CABG+MVP治疗老年IMR的手术风险、中远期心功能与死亡比例差异不明显。CABG+MVP术后有出现中度以上二尖瓣反流的可能,CABG+MVR(BV)纠正反流满意。  相似文献   

2.
目的探讨影响缺血性二尖瓣关闭不全(IMR)行二尖瓣成形术(MVP)合并冠状动脉旁路移植术(CABG)患者早期预后的危险因素。方法回顾性分析因IMR于我院行MVP并CABG的患者71例,均应用二尖瓣成形环,并分为软环组38例和硬环组33例。终点事件为术后死亡、再次二尖瓣手术、术后出现二尖瓣重度反流和心力衰竭。随访时间为(20.3±8.5)个月。结果软环组二尖瓣瓣环扩张比例显著高于硬环组,差异有统计学意义(57.9%vs 30.3%,P=0.02),Kaplan-Meier生存曲线显示,术前存在二尖瓣瓣环扩张、心功能(NYHA)>Ⅱ级和室壁瘤患者较无上述各项患者终点事件发生率更高(Plog-rank=0.018、0.044、0.001)。多因素Cox分析显示,二尖瓣瓣环扩张(HR=5.79;95%CI:1.23~27.15)、心房颤动(HR=5.14;95%CI:1.31~20.11)和升主动脉阻断时间(HR=1.03;95%CI:1.01~1.06)是影响早期预后的独立危险因素(P<0.05)。结论 IMR行MVP并CABG的患者,二尖瓣瓣环扩张、心房颤动、升主动脉阻断时间是影响其早期预后的独立危险因素。  相似文献   

3.
目的 研究冠心病伴中度缺血性二尖瓣反流(IMR)患者行不停跳冠脉搭桥单纯血运重建手术后对二尖瓣反流的影响.探讨冠心病伴缺血性二尖瓣反流的治疗策略.方法 对59例冠心病伴中度IMR行不停跳冠脉搭桥术(OPCAB);对30例冠心病伴中度IMR行体外循环下搭桥术(CABG)同期二尖瓣成形术(MVP).术后随访7~71(35.69±17.88)个月,比较两组NYHA心功能分级、二尖瓣反流程度、心超左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左室射血分数(LVEF)的改善情况.结果 两组术中平均吻合血管数无差异;OPCAB组术后引流量平均(591±346)ml,明显少于CABG+MVP组[(706±371)ml],P〈0.05.术后6个月两组NYHA心功能均优于术前,但组间差异无统计学意义(P〉0.05);CABG+MVP组IMR减轻程度明显大于OPCAB组(P〈0.05);OPCAB组术后LVEDD无改善,CABG+MVP组术后LVEDD减小(P〈0.05);两组术后LVESD均无明显变化;术后LVEF两组均改善(P〈0.05),改善程度组间差异无统计学意义.结论 OPCAB单纯血运重建手术创伤较小,术后患者的心功能及二尖瓣反流程度都得到了显著改善.虽然二尖瓣成形术在降低缺血性二尖瓣反流方面更有效.但对于中度IMR和有高度手术风险的患者,OPCAB可能是更优的治疗方案.  相似文献   

4.
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。  相似文献   

5.
目的比较二尖瓣成形术或二尖瓣置换术治疗合并室壁瘤的缺血性二尖瓣返流的围手术期及远期疗效。方法纳入2009年7月~2015年12月于中国医学科学院阜外医院因缺血性二尖瓣返流合并室壁瘤患者行二尖瓣手术者49例。按手术方式分为二尖瓣置换组9例,二尖瓣成形组40例。对上述病例的资料进行回顾性分析,并随访(3.1±2.0)年。结果两组围手术期死亡无统计学差异(P=0.569)。两组出院前二尖瓣返流情况、左室射血分数(LVEF)、左室舒张末径(LVEDD)均较术前显著改善。二尖瓣成形组LVEF高于置换组(P=0.016)。随访期死亡3例。成形组远期二尖瓣返流高于置换组(P=0.020)。末次随访时,两组LVEF、LVEDD均无统计学差异(P=0.981、0.596)。结论在合并室壁瘤的缺血性二尖瓣返流患者中,二尖瓣置换术与成形术手术风险相似。二尖瓣成形存在远期返流复发的风险,但远期生存及心功能无显著差异。  相似文献   

6.
二尖瓣成形术367例分析   总被引:2,自引:0,他引:2  
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.  相似文献   

7.
目的:回顾两种二尖瓣成形术治疗合并主动脉根部瘤的二尖瓣反流,探讨此手术的临床效果。方法:2010年7月至2015年5月,北京安贞医院收治的33例合并主动脉根部瘤的二尖瓣反流的患者进行回顾性分析,男性28例,女性5例,平均年龄(53.2±15.5)岁。其中25例患者置入二尖瓣成形环(成形环植入组),所置入的二尖瓣人工瓣环平均直径为(29.5±1.5)mm,8例患者行交界环缩术(交界环缩组)。术前超声心动图显示:所有患者二尖瓣病变均为中度或重度关闭不全,成形环植入组反流面积为(8.5±4.1)cm2,交界环缩组反流面积为(5.7±1.3)cm2。成形环植入组患者平均体外循环时间(164.2±29.3)min,平均主动脉阻断时间(118.2±23.4)min,交界环缩组患者平均体外循环时间(111.9±28.4)min,平均主动脉阻断时间(77.8±22.2)min。结果:术后无死亡,无恶性心律失常及其他严重并发症。成形环植入组术后平均ICU停留时间为(23.0±12.5)h,交界环缩组术后平均ICU停留时间为(23.0±8.8)h。复查超声心动图显示:成形环植入组少量反流8例,无或微量反流17例;交界环缩组少量反流4例,无或微量反流4例。结论:二尖瓣反流合并主动脉根部瘤时可以经房间隔切口或房间沟切口行成形环植入术和经主动脉切口行交界环缩术。上述两种二尖瓣成形术治疗主动脉根部瘤合并二尖瓣反流的效果确切,对于二尖瓣反流程度较轻的患者可以采用经主动脉切口行交界环缩术,以减少体外循环和阻断的时间。  相似文献   

8.
缺血性二尖瓣反流(IMR)是冠状动脉粥样硬化性心脏病的常见并发症。左室重构是IMR的主要发生机制。心肌梗死后发生IMR是预后不良的危险因素。对于重度IMR患者,在冠状动脉旁路移植术(CABG)同期处理二尖瓣已形成共识,但对于中度IMR患者,CABG同期是否行二尖瓣成形术尚存争议。该文介绍IMR的发生机制、反流程度的评估及治疗措施。  相似文献   

9.
缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)也称为功能性二尖瓣反流或继发性二尖瓣反流。是冠心病常见的并发症之一。二尖瓣反流的发生会加速左心室重构和功能障碍,最终导致不可逆的心力衰竭。尽管在医学和外科治疗方面取得了一定的进展,但IMR的患者与因其他原因而出现二尖瓣关闭不全的患者相比生存率较差。在外科治疗方面,此类患者尤其是中度及重度IMR患者治疗方式的选择仍存在很大争议。本文将从二尖瓣反流机制、不同程度IMR患者的外科治疗以及介入治疗的进展等方面进行阐述。  相似文献   

10.
目的 比较冠状动脉旁路移植术(CABG)复合二尖瓣成形术(MVP)与二尖瓣置换术(MVR)治疗冠状动脉粥样硬化性心脏病(CHD)合并中-重度缺血性二尖瓣关闭不全(IMR)的近期疗效.方法 回顾性分析2018年1月至2020年1月郑州大学第一附属医院心血管外科收治的80例CHD合并中-重度IMR患者的临床资料,根据二尖瓣...  相似文献   

11.
经皮二尖瓣球囊扩张术治疗二尖瓣狭窄伴中度返流   总被引:2,自引:0,他引:2  
目的 探讨经皮二尖瓣球囊扩张术 (PBMV)治疗二尖瓣狭窄 (MS)伴中度二尖瓣返流(MR)的近、远期疗效。方法 采用自制二尖瓣球囊导管治疗MS伴中度MR患者 6 2例 ,其中二尖瓣膜明显增厚、钙化者 7例 ,对左室最大前后径、二尖瓣口面积、左房平均压、二尖瓣跨瓣压差及心功能(NYHA分级 )等主要指标随访观察 12~ 36个月。结果 术后二尖瓣口面积明显增大 [(0 83± 0 18)cm2 比 (1 86± 0 2 4 )cm2 ,P <0 0 1],左房平均压 [(32± 8)mmHg比 (13± 8)mmHg ,P <0 0 1,1mmHg=0 133kPa]及二尖瓣跨瓣压差 [(18± 9)mmHg比 (5± 3)mmHg ,P <0 0 1]明显降低 ,心功能明显改善 [(2 81± 0 2 4 )级比 (1 4 6± 0 37)级 ,P <0 0 1],左室最大前后径无显著改变 [(4 5± 4 )mm比 (4 6± 4 )mm ,P >0 0 5 ]。对左室最大前后径、二尖瓣口面积及心功能等指标随访观察 12~ 36个月均无明显改变。结论 选择合适病例 ,严格把握球囊扩张终点 ,风湿性二尖瓣狭窄并中度返流患者PBMV的近、远期疗效显著。  相似文献   

12.
Opinion statement  
–  It is well recognized that the floppy mitral valve (FMV) complex is the central issue in the FMV, mitral valve prolapse (MVP), and mitral valvular regurgitation (MVR) story. MVP associated with the FMV results from the systolic movement of portions or segments of the FMV complex into the left atrium (LA). Prolapse of the FMV results in unique forms of mitral valvular dysfunction and MVR. When the FMV is recognized as the basic point of reference, diagnostic and nosologic characterizations are simplified. Each of the consequences of FMV dysfunction—MVP, MVR, and FMV surface phenomena—are dynamic entities and contribute to the symptoms and clinical course in this patient population.
–  Although MVP may occur in the absence of a FMV in individuals with small left ventricular (LV) volume, hyperdynamic, or hypercontractile LV, we do not consider this phenomenon as part of FMV/MVP/MVR.
–  The natural history of the FMV/MVP/MVR is long, and understanding the life history requires long-term follow-up with serial evaluations.
–  Identification of those individuals with FMV/MVP whose symptoms are related to, or associated with, autonomic nervous system dysfunction (ie, the FMV/MVP syndrome) is important, as this distinction has diagnostic and therapeutic implications.
–  In general, patients with FMV/MVP should receive antibiotic prophylaxis for infective endocarditis.
–  Data suggest that therapy with angiotensin-converting enzyme inhibitors for FMV/MVP and significant MVR may slow the natural regression of the disease.
–  Surgical therapy should be considered in patients with significant MVR and symptoms related to MVR.
–  Explanation for the nature of these symptoms, reassurance, avoidance of volume depletion, catecholamines or other cycle-AMP stimulants and a regular exercise program constitute the basic principles of management for patients with FMV/MVP syndrome.
  相似文献   

13.
One hundred and twenty-six patients of rheumatic mitral stenosis (MS), aged 10-30 (mean 19.5 +/- 5.9) years underwent balloon mitral valvuloplasty (BMV). All valvuloplasties were done by the anterograde transvenous, transatrial route. The procedure was successful in 120 (95%) cases. Single balloon was used in 10 patients early in the series and double balloon was used in the other 110 patients. BMV resulted in a significant increase in the mitral valve area (MVA) from 0.96 +/- 0.35 to 2.3 +/- 0.8 cm2 (p less than 0.0001) and a significant fall in the transmitral pressure gradient (TMG) from 28.2 +/- 3.2 to 7.4 +/- 4.8 mmHg (p less than 0.001). The MVA achieved by BMV was found to have a significant positive correlation with the balloon diameter to body surface area ratio (BD/BSA) (r = 0.69, p less than 0.001). New mitral regurgitation (MR) developed in 15 patients--trivial in 11, 2+ in 2 and 3+ in 2. One patient required emergency mitral valve replacement. Procedure induced MR did not have a significant relation to the balloon size, degree of mitral sub-valvular pathology or the severity of mitral stenosis. Iatrogenic atrial septal defect was detected by oximetry in none, by angiography in one patient, and by Doppler color flow imaging in 5 patients. Cardiac tamponade was the most frequent serious complication, occurring in 6 patients, 4 of whom died following emergency surgery. Sixty-five patients have been followed up for at least 6 months (range 6-30, mean 16.3 +/- 6.3 months) following BMV.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

14.
We report 7 symptomatic patients with stenotic double-orifice mitral valve of incomplete bridge type. In each patient, the fibrous bridge tissue between the valve leaflets was successfully split using an Inoue balloon valvuloplasty technique with stepwise dilations applied only to the posteromedial orifice.  相似文献   

15.
Percutaneous mitral valve repair for mitral regurgitation   总被引:5,自引:0,他引:5  
Mitral regurgitation (MR) associated with, ischemic, and degenerative (prolapse) disease, contributes to left ventricular (LV) dysfunction due to remodeling, and LV dilation, resulting in worsening of MR. Mitral valve (MV) surgical repair has provided improvement in survival, LV function and symptoms, especially when performed early. Surgical repair is complex, due to diverse etiologies and has significant complications. The Society for Thoracic Surgery database shows that operative mortality for a 1st repair is 2% and for re-do repair is 4 times that. Cardiopulmonary bypass and cardiac arrest are required. The attendant morbidity prolongs hospitalization and recovery. Alfieri simplified mitral repair using an edge-to-edge technique which subsequently has been shown to be effective for multiple etiologies of MR. The MV leaflers are typically brought together by a central suture producing a double orifice MV without stenosis. Umana reported that MR decreased from grade 3.6 +/- 0.5 to 0.8 +/- 0.4 (P < 0.0001) and LV ejection fraction increased from 33 +/- 13% to 45 +/- 11% (P = 0.0156). In 121 patients, Maisano reported freedom from re-operation of 95 +/- 4.8% with up to 6 year follow-up. Oz developed a MV "grasper" that is directly placed via a left ventriculotomy and coapts both leaflets which are then fastened by a graduated spiral screw. An in-vitro model using explanted human valves showed significant reduction in MR and in canine studies, animals followed by serial echo had persistent MV coaptation. At 12 weeks the device was endothelialized. These promising results have paved the way for a percutaneous or minimally invasive-off pump mitral repair. Evalve has developed catheter-based technology, which, by apposing the edges of a regurgitant MV, results in edge-to-edge repair. Release of the device is done after echo and fluoroscopic evaluation under normal loading conditions. If the desired effect is not produced the device can be repositioned or retrieved. Animal studies show excellent healing, with incorporation of the device into the leaflets at 6-10 weeks with persistent coaptation. Another percutaneous approach has been to utilize the proximity of the coronary sinus (CS) to the mitral annulus (MA). Placement of a self-compressing device in the CS along the region of the posterior MA has, in canine models, reduced MR and addresses the issues of MA dilation and its contribution to MR. Ongoing studies are underway for both techniques.  相似文献   

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分级次二尖瓣球囊扩张预防二尖瓣反流的初步研究   总被引:9,自引:0,他引:9  
目的为探讨经皮穿刺球囊导管二尖瓣扩张术(PBMV)引起二尖瓣反流(MR)的原因及其预防方法。方法我们采用分级次扩张法和改良Inone法对人体病变二尖瓣和硅胶二尖瓣模型进行体外球囊导管扩张实验,并对132例风湿性心脏病重度二尖瓣狭窄患者,其中分别以分级次扩张法96例,Inone法36例进行PBMV的前瞻性对比研究。结果(1)PBMV引起二尖瓣反流的原因除与瓣膜钙化程度重、瓣下结构紊乱有关以外,瓣口面积小、交界粘连处夹角小是一个重要原因。(2)分级次扩张可使交界粘合处夹角呈渐进性扩大,扩张时不易引起瓣膜撕裂和二尖瓣反流。两组比较Inone法扩张组二尖瓣反流发生率为16.7%,分级次扩张组无二尖瓣反流病例,并且术中其他并发症及术后再狭窄发生率后者也明显低于前者。结论球囊导管分级次扩张可有效地预防二尖瓣反流,是治疗二尖瓣狭窄较理想的方法。  相似文献   

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