CABG同期行左室成形术和二尖瓣成形术治疗左室室壁瘤并发二尖瓣关闭不全的效果

目的 评价冠状动脉旁路移植术（CABG）同期行左室成形术和二尖瓣成形术治疗左室室壁瘤并发二尖瓣关闭不全的近远期临床效果。 方法 自2000年1月~2008年12月，我院共32例患者因左室室壁瘤并发缺血性二尖瓣关闭不全同期进行左室成形术+二尖瓣成形术。左室成形术手术方式包括:线性缝合16例（50%）；心内膜环缩成形术9例（28%）；心室内环状补片成形术7例（22%）。二尖瓣成形术入路包括:左室入路20例（62%），右房-房间隔入路11例（34%），房间沟入路1例（3%）。全部患者均同期行CABG。本研究回顾性分析了上述患者手术中及围手术期的临床资料，并进行了46~175个月随访。 结果 围手术期死亡1例（3%）。术后1年和5年生存率分别为97%和74%。随访期间，9%（3例）出现二尖瓣中量及以上返流，9%（3例）出现NYHA心功能Ⅲ~IV级。左室成形方式及二尖瓣成形入路对远期效果无显著影响。 结论 左室成形术同期行二尖瓣成形术是治疗左室室壁瘤并发二尖瓣关闭不全的有效方法，术后的近远期临床结果令人满意。

Mitral valve reconstruction combined with left ventricular restoration and coronary artery bypass graft for post-infarction ventricular aneurysm and mitral regurgitation

AIM To evaluate our experience of mitral valve repair in combination with left ventricular restoration and coronary artery bypass graft(CABG) for post-infarction ventricular aneurysm and mitral regurgitation so as to improve the clinical results for these patients. METHODS From January 2001 to December 2008, 32 consecutive patients with left ventricular aneurysm and ischemic mitral valve regurgitation underwent mitral valve repair combined with ventriculoplasty and CABG. Clinical findings were reviewed retrospectively and the duration of follow-up was 46-175 months. RESULTS Operative mortality was 3%. One-year and 5-year survival rates were, respectively, 97% and 74%. During follow-up, three patients(9%) had NYHA class Ⅲ and IV and three patients(9%) had ≥ 2+ mitral regurgitation. The surgical technique for ventriculoplasty and the approach for mitral valve repair did not significantly affect the clinical outcomes. CONCLUSION Combined mitral and left ventricular reconstruction and coronary revascularization is effective for ischemic left ventricular aneurysm with mitral regurgitation. Short- and long-term clinical outcomes are satisfactory.