瓣膜置换术保留乳头肌-二尖瓣瓣环连续性的疗效

目的:比较二尖瓣置换术保留与不保留前、后乳头肌瓣下结构对术后早期心脏几何构型的影响。方法:手术患者分两组:保留二尖瓣下乳头肌(MVRP)组和不保留二尖瓣下乳头肌(MVR)组。在手术前及手术后7 d分别进行心脏超声心动图检查。结果:二尖瓣关闭不全(MI)组:MVRP组与MVR组术后左房、左室均明显缩小(P<0.01),但MVRP组左房缩小更多(P<0.05),且右房、右室亦明显缩小(P<0.05,<0.01);双瓣膜置换组(DVR)组:MVRP组及MVR组左房、左室、右房、右室明显缩小(P<0.05~<0.01),MVRP组的右房改善甚于MVR组(P<0.05),但左房的改善不如MVR组(P<0.01);二尖瓣狭窄(MS)组:MVRP组与MVR组术后左房、右室明显缩小(P<0.01);MVRP组右房缩小(P<0.05),左室无明显改善;而MVR组右房无明显变化,左室明显缩小(P<0.01)。结论:保持乳头肌-瓣环的连续性能最大程度地改善术后心脏功能,避免左室后壁破裂。

Therapeutic effect analysis of keeping the continuity from papillary muscle to mitral annulus in valve replacement surgery

Objective: To investigate the importance of sture and fixation of both papillary muscles to corresponsive sites under mitral annulus. Methods: These patients were divided into keeping the continuity from papillary muscle (MVRP) and no MVRP (MVR) groups. Diameter of ascending aorta (AAOD), right ventricle diastole (RVDD),right atrium diameter (RAD), left ventricle diastole (LVDD) , left atrium diameter (LAD) were measured by 2D-UCG. Results: The LVDD, LAD of MVRP and MVR groups decreased significantly (P<0. 01) after the surgery in MI patients, but LAD decreased more (P<0. 05) and RVDD also decreased more (P<0. 01) in MVRP group. LAD, LVDD, RAD, RVDD of MVRP and MVR groups significantly decreased (P<0. 05-<0. 01) in DVR patients; compared with MVR group, the RAD dereased more (P<0. 05), the LAD decreased less (P<0. 01) in MVRP group. LAD, RVDD of MVRP and MVR groups in MS patients significantly decreased (P<0. 01); RAD decreased (P< 0. 05) , but LVDD no decreased in MVRP group; RAD no significantly decreased but LVDD decreased (P<0. 01) in MVR group. Conclusion: Suture and fixation of both papillary muscles to corresponsive sites under mitral annular in valve replacements may improve the post-operative heart function.