二尖瓣闭合性损伤的诊断与外科治疗

目的二尖瓣闭合损伤临床少见。为引起大家的注意和重视。方法总结４例闭合性二尖瓣损伤的诊断与治疗的经验与教训。结果２例为外伤性二尖瓣腱索断裂，分别行二尖瓣瓣环环缩术加二尖瓣腱索修补术和二尖瓣置换术治愈。１例为外伤性二尖瓣瓣叶撕裂伤、左股动脉假性动脉瘤，合并感染性心内膜炎，急诊行二尖瓣赘生物清除、二尖瓣叶修补术、假性动脉瘤切除术、股动脉修补术治愈。１例为二尖瓣置换术后８年，外伤性人工机械瓣瓣钩断裂，致急性心衰，未及时手术而死亡，尸检证实诊断。结论作者认为闭合性二尖瓣损伤临床上易误诊。一旦诊断宜早期手术。发生急性心衰或合并感染性心内膜炎时，应急诊手术。

Surgical management of closed injury of mitral valve: report of four cases

Objective To show the experience in dealing with mitral valve injury caused by trauma.Methods Four cases of closed injury of mitral valve were treated.Results Two of the four patients presented ruptured chordae of mitral valve and were cured with annutoplasty plus repair of the chordae and mitral valve replacement respectively. One presented tearing of mitral valve leaf and pseudoaneurysm of the femoral artery, which were complicated by infective endocarditis.The patient was cured with emergency operation to repair the lesions and remove pseudoaneurysm and neoplasm in the mitral valve. Another patient, who received mitral valve replacement 8 years before, presented ruptured valve hook of the prosthesis and died of acute heart failure without prompt operation.The diagnosis was confirmed by autopsy. Conclusions The disease is easy to misdiagnose and once the diagnosis is established surgical intervention should be performed early.Emergency operation is necessary if acute heart failure occurs or infective endocarditis is complicated.