二尖瓣人工瓣环成形术18例.docVIP

二尖瓣人工瓣环成形术18例 二尖瓣人工瓣环成形术18例 2011-09-14 吴若彬　刘菁　肖学钧　张镜芳 　　【摘要】　目的　回顾性分析18例二尖瓣人工瓣环成形术的疗效。方法　风湿性病变3例，退行性变11例，先天性病变4例。重度关闭不全16例，中度关闭不全2例。根据二尖瓣病理改变对瓣叶和瓣下结构做针对性瓣膜成形术后，均植入人工瓣环。10例在经食道超声心动图监测下行成形术。结果　成形者中术后二尖瓣无返流6例，轻度返流9例，中度返流1例。2例改行二尖瓣置换术。随访7个月至6年7个月，平均3.6年，心功能均有显著改善。结论　对于有瓣环扩大的二尖瓣成形术，应用人工瓣环，近期和远期临床效果均满意。 　　【关键词】　二尖瓣环成形术　人工二尖瓣环 Prosthetic ring for mitral annuloplasty (Report of 18 cases) Wu Ruobin　Liu Qing　Xiao Xuejun （Department of Cardiac Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou 510080） 　　【Abstract】　Objective　This article is to review the experience of prosthetic mitral annuloplasty. Methods　The cause of valvular incompetence was found to be rheumatic in 3 cases, myxomatous degeneration in 11 and congenital in 4. The mitral valve incompetence was graded as severe in 16 cases and moderate in 2. All patients underwent mitral annuloplasty using prosthetic mitral ring. 10 patients underwent mitral annuloplasty in use of intraoperative transeophaged echocardiography.Results　The mitral valve incompetence was graded as no incompetence in 6 cases, slight in 9 and moderate in 1 after surgery. Two patients underwent mitral valve replacement. Patients were followed up for 7 months to 6 yeras and 7 months (average 3.6 years). Their cardiac functions were improved.Conclusion　The late efficacy of mitral annuloplasty using prosthetic ring is satisfactory. 　　【Key words】　Mitral annuloplasty Prosthetic mitral ring 　　1993年3月至1999年3月，我们为18例二尖瓣关闭不全患者施行了二尖瓣人工瓣环成形术，并进行随访，现分析报道如下： 资料与方法 　　临床资料：全组18例中男8例，女10例，年龄9～69岁，平均(23.1±15.4)岁。风湿性心脏病3例，退行性变11例，先天性病变4例。合并主动脉病变2例。心电图示窦性心律17例，心房颤动1例。心胸比率0.52～0.8，平均0.63±0.09。超声心动图检查示重度二尖瓣关闭不全16例，中度2例，二尖瓣返流面积6.2～27.32 cm2，平均(10.32±6.2) cm2；左室舒张末径52～88 mm，平均(59.75±13.3) mm。术前心功能(NYHA分级)Ⅲ级12例，Ⅳ级6例。解剖特点：二尖瓣腱索延长14例，腱索断裂4例，病人均有程度不等的二尖瓣环扩大。 　　方法：手术在全麻、低温体外循环下进行。先针对二尖瓣的瓣叶和瓣下结构的病理改变做瓣膜成形术：腱索缩短11例，瓣叶楔形切除7例。然后行人工瓣环成形术：先测量大瓣的面积，根据大瓣面积选择合适型号的人工瓣环。用2-0涤纶线在瓣环上作间断褥式缝合，在前叶侧缝4～6针，后叶侧缝6～8针，缝线分别穿过人工瓣环的内、外缘，置入人工瓣环，分别为28～32号。使用Carpentier环16例，St.Ju