动脉导管未闭合并功能性二尖瓣反流的治疗策略

目的：探讨动脉导管未闭合并功能性二尖瓣反流的治疗策略及疗效观察 方法：回顾性分析2008年1月至2015年7月在本中心实施手术治疗的65例PDA合并功能性二尖瓣反流患者的临床资料。其中有轻度二尖瓣反流16例、中度反流26例、重度反流23例，其中41例行介入封堵术，19例行左侧经胸切口动脉导管结扎术。3例成人患者合并重度二尖瓣反流者行体外循环下PDA结扎及二尖瓣成形术，2例左室明显扩大伴重度二尖瓣反流、心功能低下者先行PDA封堵后2周再行体外循环下二尖瓣成形术。术后3月随访复查心脏彩超了解二尖瓣反流情况。 结果：围术期无死亡。PDA术后均无残余分流。8例术前有反复肺部感染的患儿术后呼吸机辅助时间2～5天后顺利脱机，其余患者均恢复顺利。单纯处理PDA的患者（共60例），术后3月心彩超提示：二尖瓣无反流26例，轻度反流24例，中度反流10例，无重度反流病例。行体外循环手术者术后均恢复良好，3例一期手术者术后二尖瓣反流为轻度以下，2例分期行成形者术后二尖瓣反流为轻度、轻偏中度。 结论：对PDA合并功能性二尖瓣反流患者，单纯处理动脉导管即可获得良好的效果。对合并极重度二尖瓣反流伴左室扩大、心功能不全患者，行分期手术可获得良好的手术安全性。

Treatment Strategy for Patent Ductus Arteriosus associated with Functional Mitral Regurgitation

Objective: To investigate the treatment strategy of patent ductus arteriosus associated with functional mitral regurgitation, and its therapeutic effect. Methods: A retrospective analysis of 65 cases of PDA combined with functional mirtal regurgitation treated in our hospital. Including mild mitral regurgitation in 16 cases, 26 cases of moderate regurgitation, 23 cases of severe regurgitation. 41 cases underwent transcatheter closure, 19 cases got ductus arteriosus ligation by transthoracic incision. 3 cases of adult patients with severe mitral regurgitation got PDA ligation and mitral valvuloplasty with cardiopulmonary bypass. Two cases with severe left ventricular enlargement, significant mitral regurgitation, and cardiac dysfunction, got transcatheter closure of PDA, and got mitral valvuloplasty two weeks later. After 3 months follow-up, review the mitral regurgitation situation by echocardiography. Results: No perioperative deaths. All patients have no postoperative residual shunt. 8 pediatric patients with preoperative pulmonary infection got 2 to 5days of postoperative ventilation. The other patients all recovered smoothly. 60 patients simple processing PDA, review echocardiography 3 months after surgery, no mitral regurgitation in 26 cases, mild regurgitation in 24 cases, moderate regurgitation in 10 cases, and no cases of severe regurgitation. 3 patients with one-stage operation have mild or less mitral regurgitation. 2 patients with staged surgery have mild and mild to moderate mitral regurgitation. Conclusion: To the patients of PDA combined with functional mitral regurgitation, simple treat the PDA often can get good results. To the PDA patients combined with extremely severe mitral regurgitation, severe enlargement of left ventricular, heart failure, staged surgery can be safe.