摘要
目的:探讨二尖瓣置换术中乳头肌悬吊固定技术重建瓣下连续性的方法,在二尖瓣关闭不全合并左心室功能严重受损的患者中临床应用效果。方法:回顾性分析2013年6月至2016年7月,在我院心外科,因二尖瓣关闭不全合并左心室功能严重受损,需行二尖瓣置换术且应用乳头肌悬吊固定技术,作为重建瓣下结构连续性的方法的患者临床资料22例,男性15例,女性7例;年龄36~75岁,平均年龄(59.18±11.5)岁;心功能(NYHA分级)Ⅲ级17例,Ⅳ级5例,心房颤动18例。病因包括感染性心内膜炎(4例)、退行性变(13例)、缺血性二尖瓣返流(3例)及风湿性改变(2例)。结果:22例患者在二尖瓣置换术中,全部切除二尖瓣前叶及瓣下腱索、大部分后叶及腱索,保留后叶基底部及与之相连的基底部腱索,再将前后乳头肌分别悬吊固定于后瓣环相应的位置以重建瓣下结构的连续性,最后以间断或连续缝合法置入人造瓣膜。本组置入机械瓣12枚,生物瓣10枚,同期行左心耳缝闭及左心房折叠术17例,心房颤动射频消融术15例,冠状动脉旁路移植术3例,三尖瓣成形15例。1例死于术后严重肺部感染,其余均顺利出院,21例患者随访,随访时间12~40个月,平均(26.14±8.16)个月。随访期间1例发生感染性心内膜炎,其余患者心功能改善,人造瓣膜功能良好,无瓣膜功能障碍及抗凝治疗导致的出血或栓塞并发症。术后及随访期间心胸比、左心室舒张期末径及收缩期末径、球形指数较术前明显改善,左心室收缩功能在术后早期得到改善,表现为左心室射血分数明显提高,随访期进一步改善。结论:应用乳头肌悬吊固定技术重建二尖瓣下结构连续性的方法,在二尖瓣关闭不全合并左心室功能受损的二尖瓣置换术中安全有效,与传统的保留二尖瓣下结构的技术相比,简单易行,易于掌握,近中期疗效满意。
Objective： To investigate the feasibility and outcome of performing papillary muscle repositioning（ PMR） as subvalvular apparatus reconstruction for mitral valve replacement procedure in patients with mitral insufficiency（ MI） and left ventricular dysfunction. Methods： Retrospectively analyze clinical data of 22 patients with MI who underwent MVR with PMR in the Department of Cardiac Surgery of Beijing An Zhen Hospital from June 2013 to July 2016. 15 of them were males and 7 were females,aging from 36 to 75（ 59. 18 ±11. 5） years. 17 of them were in New York Heart Association classification functional class Ⅲ and 5 patients in class Ⅳ,preoperatively. The pathology of mitral valve includes infection（ 4 patients）,degeneration（ 13 patients）,ischemic regurgitation（ 3 patients） and rheumatic changes（ 2 patients）. Results： MVR combined with papillary muscle repositioning（ PMR） was performed for all the patients. 12 patients received mechanical valves,and 10 patients received bioprosthetic valves. Concomitant procedures includes coronary artery bypass grafting（ 3 patients）,excision of left atrial appendage and placation of left atrium（ 17 patients）,tricuspid valvuloplasty（ 15 patients）,and radiofrequency ablation of atrial fibrillation（ 15 patients）. One patient died of severe pulmonary infection and 21 patients survived. There was no postoperative low cardiac output syndrome or left ventricular rupture. All the 21 patients were followed up for a mean duration of 26. 14 ± 8. 16 months（ range12 to 40 months）. During follow-up,1 patient suffered from infective endocarditis and needed reoperation six months after discharge,the other patients showed improvement of heart function and quality of life. None of these patients had anticoagulation or prosthetic valve related complication. Cardiothoracic ratio,left ventricular end-diastolic dimension（ LVEDD）,left ventricular end-systole dimension（ LVESD） and left ventricular sphericity index（ LVSI） showed s
作者
张富恩
李继勇
伯平
张健群
任瞳
曹向戎
ZHANG Fuen;LI Jiyong;BO Ping;ZHANG Jianqun;REN Tong;CAO Xiangrong(Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Belting Institute of Heart,Lung and Blood Vessel Diseases, Beijing 100029, China)
出处
《心肺血管病杂志》
2018年第6期542-546,共5页
Journal of Cardiovascular and Pulmonary Diseases
关键词
二尖瓣关闭不全
二尖瓣置换术
瓣下结构保留
重建
Mitral insufficiency
Mitral valve replacement
Chordal-sparing
Reconstruction
