术前左心室大小及其术后缩小程度与二尖瓣成形早期预后的相关性研究

目的分析影响退行性二尖瓣反流行成形术早期预后的危险因素。方法回顾性分析2011年1～11月在北京阜外心血管病医院行二尖瓣成形术的二尖瓣退行性变患者，入组患者132例，随访患者114例（86．4％），平均年龄（51．21±12．78）岁，其中男76例（66．7％）、女38例（33．3％），通过回访成形术早期的效果对术前危险因素进行分析。结果入选患者合并心房颤动25例（21．9％），术前射血分数63．88％±6．93％，术前超声心动图提示左心室舒张期末内径指数（31．61±5．51）mm／m^2，合并i尖瓣关闭不全者56例（49．1％），其中34例（29．8％）同期行三尖瓣成形术，10例（8．8％）应用三尖瓣成形环。术后死亡2例，再次行二尖瓣置换术或成形术2例，超声心动图复查提示二尖瓣中量及以上反流15例。影响二尖瓣成形早期预后的危险因素包括合并心房颤动（36．8％vs．18．9％，P=0．035）、较大的左心室舒张期末内径指数（34．02±3．76）mm／m^2 vs．（31．15±5．68）mm／m^2，P=-0．042]、功能性二尖瓣反流（15．8％vs．1．1％，P=0．007）。多因素分析结果显示手术前后左心室内径改变（主要是缩小）越大，术后事件发生率降低HR0．002，95％CI（〈0．001，0．570），P=0．031]。结论对于二尖瓣退行性反流的患者，术前左心室扩张是影响二尖瓣成形术早期预后的独立危险因素，而此类患者中，左心室内径明显缩小者，术后事件发生率降低。

Preoperative Left Ventricular End-diastolic Diameter and Its Postoperative Reduction Influence Early Outcomes of Mitral Valvuloplasty for Degenerative Mitral Regurgitation

Objective To analyze risk factors of early outcomes of mitral valvuloplasty （MVP） for the treatment of degenerative mitral regurgitation （DMR）. Methods Clinical data of 132 DMR patients who underwent MVP in Fu Wai Hospital between January 1,2011 and November 1, 2011 were retrospectively analyzed. A total of 114 patients （86.4%） were followed up after discharge with their mean age of 51.21 ＋ 12.78 years, including 76 males （66.7%）. Preoperative risk factors of early outcomes of MVP were analyzed. Results Among those patients, there were 25 patients with atrial fibrillation （AF） （21.9%）. Preoperative ejection fraction was 63.88±6.93%. Preoperative echocardiography showed left ventricular end-diastolic diameter （LVEDD） was 31.61± 5.51 mm/m^2. There were 66 patients （ 57.9 % ） with tricuspid regurgitation, and 34 patients （29.8%） underwent concomitant tricuspid valvuloplasty including 10 patients （8.8%） who received tricuspid annuloplasty rings. Two patients died postoperatively, 2 patients underwent re-operation of mitral valve replacement or MVP respectively. Postoperative echocardiography showed moderate or severe mitral regurgitation in 15 patients. Preoperative risk factors of early outcomes of MVP included AF （ 36.8% vs. 18.9%,P=0.035 ）, large LVEDD （ 34.02 ± 3.76 mm/m^2 vs. 31.15 ±5.68 mm/m2, P=0.042） and functional mitral regurgitation （ 15.8% vs. 1.1%, P=0.007）. Multivariate analysis showed greater postoperative LVEDD reduction significantly lowered the incidence of postoperative events （HR 0.002, 95% CI 〈 0.001-0.570,P=0.031 ）. Conclusions Enlargement of the left ventricle is an independent preoperative risk factor for early outcomes of MVP for DMR patients. Greater postoperative LVEDD reduction significantly lowers the incidence of postoperative events.