二尖瓣人工腱索移植术105例手术分析

目的 总结二尖瓣人工腱索移植术的手术治疗经验.方法 选择应用二尖瓣人工腱索移植术治疗的退行性二尖瓣脱垂并关闭不全患者105例.其中,单纯人工腱索移植25例,人工腱索移植＋后叶楔形切除67例,人工腱索移植＋后叶楔形切除＋Sliding 13例.结果 术后早期无死亡病例.术后并发症：窦性心动过缓8例、室上性心动过速20例、延迟性心包填塞1例、术前心房颤动伴快-慢综合征患者永久起搏器置入l例,均治愈出院.住院时间9～21 （14±4）d.术后随访96例,随访率91.4％（96/105）.随访3个月至5年.96例随访患者中,l例术后13个月死于脑梗死,1例死于交通事故,余94例均存活.NYHA心功能分级Ⅰ级74例,Ⅱ级20例.复查心脏彩超示微量及以下反流92例,轻度反流2例,未发现人工腱索断裂或劈裂.结论 严格选择病例,掌握恰当的手术技巧,同时做好术中成形效果的评估和体外循环期间的心肌保护,是提高二尖瓣人工腱索移植术疗效的关键.

Analysis of mitral artificial chordae transplantation in 105 cases

Objective To summarize the experience of application of artificial chordae transplantation in mitral valve repair.Methods One hundred and five patients with mitral regurgitation due to mitral degeneration,underwent mitral valve repair with artificial chordae transplantation.Operative technique included simple Gore-Tex artificial chordae transplantation in 25 cases,artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 67 cases,artificial chordae transplantation plus quadrangular resection of the posterior leaflet and Sliding technique in 13 cases.Results No early death occurred after operation.The postoperative complications were caused in 30 patients including sinus bradycardia in 8 cases,supraventricular tachycardia in 20 cases,late cardiac tamponade in onecase,pacemarker implantation in one case.Hospital time was 9-21 （14 ±4） d.Follow-up was done to 96 patients for 3 months to 5 years with a follow-up rate of 91.4％（96/105）.Among 96 cases,one died of cerebral infarction after 13 months,one died from accident while the remaining were alive,74 cases were with cardiac function （NYHA） of grade Ⅰ and 20 cases with grade Ⅱ.No regurgitation was found in 92 cases,mild regurgitation in 2 cases.There were no artificial chordae ruptures.Conclusions The key to improve the early and midterm results of artificial chordae transplantation are to choose patients strictly,to grasp proper surgical skills,to do a good job in intraoperative shaping effect evaluation and the myocardial protection during extracorporeal circulation.