巨大左心室瓣膜置换术后早期左心功能恢复的评价

目的探讨超声心动图评价合并巨大左心室(＞70 mm)瓣膜病接受瓣膜置换术中原位保留二尖瓣结构的效果.方法本组37例,均在体外循环心脏不停跳下进行二尖瓣置换手术,其中,原位完整保留全部二尖瓣结构14例(保留全瓣组);仅保留后瓣及其腱索,切除前瓣及其腱索23例(保留后瓣组).术后1个月采用超声心动图评估手术前后两组左心室舒张末容积指数(LVEDVI)、收缩末容积指数(LVESVI),左心室舒张末直径(LVEDD)、收缩末直径(LVESD),左心室射血分数(EF)、短轴缩短率(FS),每搏指数(SVI),收缩期左心室流出道血流速度等变化.结果保留全瓣组无手术早期死亡病例,发生严重心律紊乱和低心排综合征各1例(7.1%,1/14);保留后瓣组手术早期死亡1例(4.3%,1/23),发生严重心律紊乱1例(4.3%,1/23),低心排综合征2例(8.5%,2/23).超声心动图显示,两组术后LVEDVI、LVESVI、LVEDD、LVESD均较术前明显缩小(P＜0.01),保留全瓣组LVEDVI、LVEDD又较保留后瓣组明显缩小(P＜0.05);EF、FS和SVI两组均优于术前(P＜0.01);收缩期左心室流出道血流速度术后两组均无明显加快;瓣膜功能正常.结论在合并巨大左心室的二尖瓣置换手术中原位完整保留全部二尖瓣结构技术,术后早期左心功能恢复良好,采用超声心动图检查评价左心功能恢复是一种准确、简便及无创伤的技术.

Evaluation of early postoperative recovery of left function after mitral valve replacement for chronic mitral disease combined with giant left ventricle

Objective To evaluate the efficacy of preservation of valve and subvalvular apparatus at anatomic position in mitral valve replacement for chronic mitral disease combined with giant chamber of left ventricle (>70 mm) by echocardiography. Methods Of the 37 cases which under went mitral valve replacement on-pump with beating heart, 14 cases had been preserved total valve and subvalvular apparatus at anatomic position (total preservation group), and 23 cases had been preserved partial valve and subvalvular apparatus group (partial preservation group). The ventricular end-diastolic and end-systolic left volume indexes (LVEDVI, LVESVI), left ventricular end-diastolic and end-systolic diameter (LVEDD, LVESD), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (FS), stroke volume index (SVI), and the blood flow velocity in left ventricular outflow tract (LVOT) were measured by echocardiography in one month after operation. Results No early operative death in total preservation group, and there was only one case of severe ventricular arrhythmia (7.1%, 1/14) and one low cardiac output syndrome (7.1%, 1/14). There were one case severe ventricular arrhythmia (4.3%, 1/23) and two low cardiac output syndrome (8.5%, 2/23) in partial preservation group, and the early mortality was 4.3% (1/23). The echocardiography showed LVEDVI, LVESVI, LVEDD and LVESD decreased significantly than pre-operation (P<0.01) in two groups. LVEDVI and LVEDD were significantly lower in total preservation group than in partial preservation group (P<0.05). EF, FS and SVI were improved significantly than pre-operation (P<0.01) in two groups. No signs suggested accelerations in LVOT blood flow velocity. The heart function recovered well. Conclusion The total preservation of valve and subvalvular apparatus at anatomic position in mitral valve replacement can significantly improve the early efficacy of operation for mitral valvular disease combined with giant chamber of left ventricle. Echocardiography is a single, accurate and safe method to evaluate the early post-operative recovery of left ventricular function.