保留二尖瓣后瓣下结构的二尖瓣置换术对左室构型及功能的影响.docVIP

保留二尖瓣后瓣下结构的二尖瓣置换术对左室构型及功能的影响 　　作者：刘进平, 韩涛, 徐驯宇, 郭薇, 黄烽, 李梅珍 　　摘要: 目的 评价保留二尖瓣后瓣下结构的二尖瓣置换术对左室构型及功能的影响。方法 选择因慢性风湿性心瓣膜病而行二尖瓣置换术(MVR)者79例,其中保留二尖瓣后瓣下结构组(MVRP)40例,不保留二尖瓣后瓣下结构组(MVRNP)39例,再根据病因不同分为二尖瓣狭窄(MS)组29例(MVRP 14例,MVRNP 15例),二尖瓣关闭不全(MI)组27例(MVRP 15例,MVRNP 12例)和双瓣置换术(DVR)组23例(MVRP 11例,MVRNP 12例)。分别于术前、术后7 d和3月三维超声测量左房面积(LAA)、左室短轴缩短率(FS)、左室舒张期末容积(LVEDV)及收缩期末容积(LVESV)，并计算左室射血分数(LVEF)。 结果 术后3月,MVRP组MI及DVR患者FS、LVESV、LVEF、LAA及LVEDV优于MVRNP组(P0.05);两组MS患者差别无统计学意义(P0.05); MVRP组左室构型呈椭圆形,MVRNP组呈偏心形或圆形。结论 与不保留二尖瓣后瓣下结构的MVR术比较,保留二尖瓣后瓣瓣下结构的MVR术对于MI、DVR患者更有利于改善左室构型及左室功能。 　　关键词: 二尖瓣; 心脏瓣膜假体置入; 心室重构; 心室功能,左; 心缩期 　　The Configuration and Function of Left Ventricle 　　after Mitral Valve Replacement with Subvalvular Preservation 　　Liu Jinping, Han Tao, Xu Xunyu, Guo Wei, Huang Feng, Li Meizhen 　　1.Department of Cardiac Surgery; 　　2.Department of Ultrasound Echocardiogram,Fujian Povincial Hospital, Fuzhou 350001,China 　　ABSTRACT: Objective To make an evaluation of the effect of mitral valve replacement(MVR) with the subvalvular preservation on the configuration and function of left ventricle. Methods 79 patients with chronic rheumatic valvular disease were taken and divided into two groups according to the form of operations: the mitral valve subvalvular preservation(MVRP) group(n=40) and the non preservation(MVRNP) group(n=39). The mitral valve stenosis(MS) group was 29 cases(including 14 MVRP and 15 MVRNP), the mitral incompetence(MI) group was 27 cases(including 15 MVRP and 12 MVRNP), and the double valve replacement(DVR)group was 23 cases(including 11 MVRP and 12 MVRNP). The left atria area(LAA), fractional shortening(FS), left ventricular enddiastolic volume(LVEDV) and left ventricle endsystolic volume(LVESV) before 7 days and 3 months after the operation were measured with 3D ultrasonometry and the ejection fraction was calculated, respectively.Results The FS, LVESV and LVEF of patients in MI and DVR subgroups in MVRP group were more ameliorated than t