成人二尖瓣置换术后瓣膜不匹配现象临床观察

目的 观察成人二尖瓣置换(MVR)术后瓣膜不匹配现象(PPM)的发生情况、PPM的影响因素和PPM对患者的影响.方法 观察MVR手术102例,其中男性36例,女性66例;年龄35-71(56.5±8.0)岁;手术方法为全麻体外循环下行MVR手术,合并三尖瓣脱垂或三尖瓣关闭不全者、冠脉病变者及巨大左心房者同期行三尖瓣瓣环成形术(TAP)、冠脉搭桥术(CABG)及巨大左房折叠术;术后随访1年,按照随访时有效瓣口面积指数(EOAi)≤1.2cm2/m2定义为PPM,102例被分为PPM组和非PPM(non-PPM)组,将肺动脉收缩压(SPAP)≥40mmHg(1mmHg=0.133kPa)定义为肺动脉高压(PAH),比较两组患者术前、围术期及术后各项指标.结果 随访发现PPM20例,发生率19.61%;PPM组男性比例、术前体表面积(BSA)、围术期25mm瓣膜的应用、随访时BSA、SPAP、EOAi、PAH、心功能分级(NYHA)≥3-4、右心衰竭及肺内感染发生较non-PPM组有统计学差异(P<0.05).结论 成人MVR术后PPM现象并不少见,术中避免使用25mm瓣膜可以减少PPM的发生.

Prosthesis-patient mismatch after mitral valve replacement in adults

Objective To observe the incidence of prosthesis-patient mismatch(PPM) after mitral valve replacement(MVR) in adults and its effect on systolic pulmonary artery pressure(SPAP),heart function and pulmonary infection of patients with mitral valvular diseases.Methods One hundred and two patients(36 males,66 females) at the age of 35-71 years(56.5±8.0 years) who underwent MVR from September 2008 to October 2010 in our hospital were included in this study.MVR was performed under general anesthesia and extracorporeal circulation.Tricuspid annuloplasty(TAP),coronary bypass(CB) and left atrium folding were performed for those complicated with triscupid prolapse or insufficiency,coronary artery disease(CAD) and huge left atrium.The patients were followed up for 1 year after operation.When the effective orifice area(EOAi) of mitral valve≤1.2cm2/m2 was defined as PPM,the 102 patients were divided into PPM group and non-PPM group.SPAP≥40mmHg was defined as pulmonary artery hypertension(PAH).Data about the patients in two groups were compared before,during and after operation,respectively.Results PPM occurred in 20 patients during the follow-up,with the incidence of 19.61%.The proportion of PPM of male patients,BSA before operation,application of 25mm valve during operation,and BSA,SPAP,EOAi,PAH,NYHA≥3-4,right heart failure and pulmonary infection during the follow up were significantly higher in PPM group than in non-PPM group(P<0.05).Conclusion PPM is not uncommon in adults after MVR.The incidence of PPM can be reduced by avoiding the use of 25mm valve during MVR.