二尖瓣成形术的临床体会

目的总结36例二尖瓣成形术的临床经验。方法实施二尖瓣成形术36例，其中后叶矩形切除13例，“双孔法”3例，后叶腱索转移1例，后叶矩形切除＋“双孔法”4例，前、后交界环缩2例，单纯放人工瓣环11例，瓣叶裂修补1例，二尖瓣肿瘤切除1例。28例置入人工瓣环，其中Edward软环19例、Medtronie软环9例。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26例，少量反流10例。1例术后第10天发生心律失常死亡。患者术前心脏彩超检查：左房（LA）（49．06±13．79）mm，左室（LV）（59．79±11．23）mm。术后心脏彩超检查：左房（39．47±6．63）mm，左室（50．21±5．07）mm。术后3个月随访心脏彩超检查：左房（35．26±5．42）mm，左室（45．18±4．25）mm。35例随访1～18个月，心功能I级31例、Ⅱ级4例。结论二尖瓣关闭不全采用相应的成形技术，可以取得良好的早、中期治疗效果。

Mitral valve repair for mitral recurcitation in 36 patients

Objective To review the experience of mitral repair for mitral regurgitation in 36 pateints. Methods From May 2006 to December 2007, 36 patients with mitral regurgitation （MR） underwent mitral repair at Fu Wai Hospital of Qing Dao. There were 23 males and 13 females ranging from 20-70 （53.28±13.68） years old. Operative technique included quadrangular resection of the posterior leaflet in 13 eases, double orifice repair in 3 eases, posterior leaflet mobilization in 1 eases, quadrangular resection of the posterior leaflet plus double orifice repair in 4 eases, anterior and posterior commissural placation in 2 cases, and repair of endorearditic lesions in 1 cases. Of 36 cases,28 were implanted annular rings, of which 19 Edward annular rings were implanted and 9 Medtronie annular rings were implanted. Results Postoperative eehoeardiography demonstrated 0 to 1 MR in 26 patients and 1＋ MR in 10 patients. One patient died of ventricular tachyeardia on the lOth day postoperatively. The mean volume of left atrium was （39.47±6.63）mm at the early postoperative period, and （35.26±5.42）mm at three months after operation . Meanwhile,the mean volume of left ventricle was （50.21±5.07）mm at the early postopera- tive period, and （45.18±4.25）mm at three months postoperatively. At the follow-up from 1-18 months, 31 patients are class I heart function, and 4 patients are cases II. Conclusion Satisfactory surgical repair outcome can be achieved in the early and midterm fonow-up of the treatment of mitral regurgitation. The key point of the repair is correct diagnosis of the anatomical lesions during the operation, as well as using appropriate repair technique.