冠心病合并二尖瓣返流的二尖瓣成形术104例临床分析

目的:回顾分析同期行二尖瓣成形和冠状动脉搭桥术的临床经验。方法:104例病人中男性60例,女性44例。冠状动脉单支病变6例,左主干病变7例,双支病变40例,三支病变58例。合并室壁瘤7例,室间隔穿孔4例,主动脉瓣病变7例。均在全麻体外循环下行冠状动脉旁路手术同时行二尖瓣成形手术,同期行主动脉瓣置换术5例,三尖瓣成形手术26例,室壁瘤切除3例,室间隔穿孔修补4例,冲洗射频迷宫消除房颤术1例。冠状动脉搭桥平均(3.33±1.5)支(1-6支)。结果:死亡1例(0.96%),术后随访二尖瓣返流0-Ⅰ级78例(75%),Ⅱ级23例(22.1%),Ⅲ级3例(2.9%)。结论:冠状动脉搭桥术同期二尖瓣成形手术效果良好,近期效果满意。

A Clinical Analysis of 104 Cases Mitral Valvuloplasty Operation on Coronary Heart Disease Patients

Objective: To study the clinical results and operative methods of mitral valve valvuloplasty in patients with coronary heart disease and mitral insufficiency.Methods: A total of 104 patients with mitral valve insufficiency caused by coronary heart disease had been treated with valve repair procedure.The surgery was performed in extracorporeal circulation and moderate hypothermia.Most patients were three-branch disease(58 cases) or double-branch disease(40 cases).The main pathologic characters of the mitral valve were mitral valve annular dilatation(100 cases,98%),anterior and posterior leaflet prolapse(28 cases) and tendon rupture(5 cases).The surgery consisted of complex methods to repair mitral valves,include rings annuloplasty,closure of the commissure,chords reimplantation and so on.Results: Seventy-eight patients have 0 to Ⅰ class mitral valve regurgitation and 23 patients had Ⅱ class mitral valve regurgitation during the retrial period by echocardiography,only one case dead.Conclusion: The mitral valvuloplasty operation on mitral valve regurgitation of coronary heart disease has good recent outcomes.