预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂

目的:回顾预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂,探讨此手术对二尖瓣脱垂的治疗效果。方法:2008年1月至2012年12月间,回顾性分析北京安贞医院收治的15例二尖瓣脱垂患者,其中男性10例,女性5例,年龄(48.5±3.2)岁,SBE后腱索断裂导致关闭不全2例,单纯腱索断裂导致关闭不全8例,腱索延长导致关闭不全5例。术前超声心动图(TEE)显示:根据Carpentier标准,前叶脱垂10例,后叶脱垂3例,前叶合并后叶脱垂2例。所有患者二尖瓣均为重度关闭不全,反流面积(11.0±0.9)cm2,1例合并三尖瓣重度反流。术前射血分数(EF)平均(64.9±1.9)%,左心室舒张末直径(LVDD)平均(54.9±1.4)mm,左心房直径(LA)平均(42.9±1.7)mm。所有患者均经胸正中切口,体外循环下行预制人工腱索环移植,移植腱索数量为(3.6±0.3)根,腱索长度(15.4±1.5)mm,平均体外循环时间(113±11.7)min,平均主动脉阻断时间(86±9.8)min。3例患者置入SJ成形环,12例患者置入爱德华成形环,1例患者同时行三尖瓣成形术。结果:术后无死亡,无恶性心律失常及其他严重并发症。术后复查TEE显示少量反流3例,微量反流8例,未见反流4例。术后EF平均(60.2±2.9)%,未见明显改变。LVDD平均(46.5±1.1)mm,LA平均(32.9±1.2)mm,均较术前明显改善。随访12~57个月,平均(35.7±4.3)个月,少量反流3例,无或微量反流12例。结论:预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂近中期效果确切,但是远期预后尚需进一步观察。

Mitral valve prolapse corrected with artificial chordae loop technique and annuloplasty ring

Objective：To evaluate the patients with mitral valve prolapse corrected with artificial chordae loop technique and annuloplasty ring.Methods：From Jan.2008 to Dec.2012,15 patients with mitral valve prolapse underwent artificial chordae loops and annuloplasty ring implantation.There were 10 males and 5 females,the average age was （48.5 ± 3.2） years,regurgitation caused by chordal rupture after SBE in 2 patients,regurgitation caused by simple chordal rupture in 8 patients,regurgitation caused by chordal extension 5 patients.Preoperative echocardiography demonstrated：prolapse of anterior leaflet in 10 patients,posterior leaflet in 3 patients,and both leaflets in 2 patients according to carpentier standard,severe mitral regurgitation existed in all patients,regurgitation area （11.0 ± 0.9） cm2.Severe tricuspid regurgitation was present in one case.Preoperative EF value was（64.9 ± 1.9）％,left ventricular diastolic diameter （LVDD） was （54.9 ±1.4） mm,diameter of left atrium （LA） was （42.9 ± 1.7） mm.Mitral prolapse was corrected with artificial chordae loops and annuloplasty ring implantation.The chordae loop number was （3.6 ± 0.3）,and chordal length was （15.4 ± 1.5） mm.Mean CBP time was （113 ± 11.7） minutes,mean aortic clamped time was （86 ± 9.8）minutes.St.Jude rings were implanted in 3 cases and Edwards rings in 12 cases for annuloplasty.Concomitant procedure included tricuspid valve annuloplasty in one case.Results：No perioperative death and serious complications occurred in these patients.Postoperative echocardiography demonstrated mild mitral regurgitation （MR） in 3 patients,trace MR in 8 patients and no MR in 4 patients.Postoperative EF value was （60.2 ±2.9） ％.LVDD （46.5 ± 1.1）mm and the diameter of LA （32.9 ± 1.2） mm,decreased significantly.The follow-up ranged from 12 ～ 57 months,mean （35.7 ± 4.3）months.Mild MR was observed in 3 cases,no and trace MR in 12 cases.Conclusion：Artificial chordae loop technique and annuloplasty ring were easy and effective to correct mitral valve prolapse.The early and mid-term outcome was satisfactory,and long-term result required further investigation.