"纽扣状"转移保留二尖瓣全装置瓣膜置换及其对左心功能的影响

目的：探讨风湿性心脏病二尖瓣病变以狭窄为主的病人采用“钮扣状”转移保留全瓣装置二尖瓣置换的方法及对左心功能的影响。方法：对80例二尖瓣狭窄需行二尖瓣置换的患者，分为：A组(术中“钮扣状”保留全部二尖瓣瓣下结构)．B组(术中仅保留二尖瓣后瓣及瓣下结构)和C组(术中未保留瓣下结构)；术前、术后3～6个月行超声心动图检查。结果：A组术后左室舒张末（LVEDV）、收缩末（LVESV）容积，左室射血分数(LVEF)、短轴缩短率（LVFS）的改善优于B、C组，对于射血分数的改善A组显著优于B、C组。A、B组主动脉阻断时间较C组延长，但A、B两组无显著差异。总体转流时间C组较A、B两组缩短。结论：风湿性心脏病以二尖瓣狭窄为主的病人行瓣膜置换时可采用“纽扣状”转移保留全部瓣下装置；病人术后早期心功能的改善优于部分保留组和不保留组。

Clinical research in preservation of the entire mitral subvalvular apparatus during mitral valve replacement in patients with mitral stenosis

Objective: To evaluate the surgical technique and the effect of preservation of the entire mitral subvalvular apparatus during mitral valve replacement(MVR)in patients with mitral stenosis．Methods：MVR was performed on 80 patients with mitral stenosis．Of them，26 had complete preservation of the entire mitral subvalvular apparatus(group A)with the technique of preservation of ‘button-shaped’transplantation．30 had the preservation of the posterior leaflet only(group B)，and the other 20 underwent the conventional MVR(group C)．Pre- and postoperative hemodynamic parameters were measured to determine the left ventricular performance．Echocardiography was performed preoperatively and 3～6 months postoperatively to determine the dimensions and ejection function. Results: The LVEDV, LVESV, LVEF, LVFS in group A was better than group B and group C, and EF in group A was best in those 3 groups. There appeared a long cross-clamp time in group A and group B，while the total CPB time in group C was shorter than group A and group B. Conclusions: The surgical skills of preservation with ‘button-shaped’transplantation may be a prectical choice for patients with mitral stenosis．The preservation of entire mitral subvalvular apparatus improves the left ventricular functions after MVR in patients with mitral valve stenosis