二尖瓣成形术的临床研究(附131例报告)

目的 总结二尖瓣成形手术方法 和临床效果.方法 对131例各种病因引起的二尖瓣关闭不全实施成形手术,术中发现二尖瓣的病理改变有瓣环扩大、瓣叶脱垂、瓣叶裂、瓣叶增厚、钙化、赘生物形成和腱索断裂、三瓣化等.成形的方法有:瓣环环缩、交界缝缩、补片扩大前叶、双孔成形、后叶矩形切除、钙化灶及赘生物切除、人工瓣环植入等.术中采用注水试验和经食管超声检查成形效果.结果 手术死亡2例,二次开胸止血3例,急性肾功能衰竭2例.术后1周、3个月及9个月心脏彩超检查:左房内径、左室舒张末径缩小,左室射血分数提高.术后9个月心脏彩超检查:无或轻度返流98例,中度返流29例,重度返流2例(1例于10个月后行二尖瓣置换术).结论 术中根据瓣膜不同的病理改变特点,灵活采用多种成形方法 ,可以取得较好的成形效果,术中经食管超声或注水试验效果不佳者,应考虑瓣膜置换.

Clinic study of cardic mitral valvoplasty (131 cases report)

Objective To evaluate the operative methods and effectiveness of surgical cardic mitral valve repair for mitral valve insufficiency.Methods From December 2003 to December 2006,131 patients were subjected to valvoplasty.The predominant pathological changes of mitral valve included annular dilation,valvular prolapse,leaflet lesions,fibrous thickening and calcification of leaflets,neoplasm in valve,chordal rupture,tricuspid mitral valve,etc.The surgical procedures consisted of various methods to repair mitral valve,including rings annulop lasty,closure of the commissure,a pericardial patch applied to enlarge anterior leaflet of mitral valve,double-orifice technique,removal of vegetations and calcification,mitral annuloplasty,etc.The results were evaluated by saline injection test and transesophageal echocardiography.Results The surgical mortality was 1.5% (2/131).Three cases received re-operation for mediastinal hemorrage.There were 2 cases of acute renal failure.The left atrial dimension and left ventricular end-diastolic diameter of all the patients were decreased while the LVEF% were increased 3 months and 9 months respectively after operation.Nine months after operation,no or mild mitral valve regurgitation was observed in 98 patients and moderate regurgitation in 29 patients,severe regurgitation in 2 cases (1 patient were subjected to mitral valve replacement 10 months after first operation).Conclusion Flexibly utilizing many kinds of mitral valvoplasty methods,according to pathological changes of mitral valve,can attain a perfect effect.If the results of saline injection test or transesophageal echocardiography are not satisfactory,valve replacement should be selected.