摘要
背景:保留全瓣瓣下结构在瓣膜置换手术中争议不断,对于瓣膜疾病术式的选择尚无统一且可靠标准。目的:探讨分析保留二尖瓣瓣下结构的瓣膜置换促进瓣膜有效愈合的效果。方法:选取2018年1-12月十堰市太和医院收治的因二尖瓣关闭不全为主要病变合并或不合并主动脉瓣疾病,行保留二尖瓣瓣下结构二尖瓣膜置换、二尖瓣及主动脉瓣双瓣置换的患者68例,其中保留全瓣瓣下结构11例、保留后瓣瓣下结构35例、二尖瓣及瓣下腱索全切22例。术后6个月进行超声心动图复查,比较3组患者左房舒张期末前后径、左室舒张期末横径、左室射血分数、左室短轴缩短率等心功能指标,以及左室流入道及流出道、各瓣膜功能、瓣周愈合情况;并记录术后3年内患者并发症情况。结果与结论:(1)保留全瓣瓣下结构组和保留后瓣瓣下结构组患者体外循环时间、阻断时间、ICU停留时间、术后住院时间均低于二尖瓣及瓣下腱索全切组(P<0.05);(2)3组患者左房舒张期末前后径、左室舒张期末横径、左室射血分数、左室短轴缩短率等心功能指标水平差异无显著性意义(P>0.05),但保留全瓣瓣下结构组左房舒张期末前后径和左室舒张期末横径低于保留后瓣瓣下结构组和二尖瓣及瓣下腱索全切组,缩小较明显;而保留全瓣瓣下结构组左室射血分数和左室短轴缩短率高于保留后瓣瓣下结构组和二尖瓣及瓣下腱索全切组,恢复较明显;(3)随访3年内3组患者并发症发生率差异无显著性意义(P>0.05);(4)结果说明,虽然二尖瓣关闭不全为主要病变合并或不合并主动脉瓣疾病患者行保留二尖瓣瓣下结构二尖瓣膜置换、二尖瓣及主动脉瓣双瓣置换对心功能影响无明显差异,但数据结构来看,保留二尖瓣瓣下结构的瓣膜置换患者术后瓣膜愈合较明显,相对具有一定优势;且术后3年内并发症无明显差异。因此,保留二�
BACKGROUND:Preservation of the subvalvular apparatus in valve replacement surgery remains controversial and there is no uniform and reliable standard for the selection of surgical procedures for valve diseases.OBJECTIVE:To explore and analyze the effect of valve replacement with preservation of the mitral valve subvalve apparatus to promote effective valve healing.METHODS:This study enrolled 68 patients with mitral insufficiency as the main disease combined with or without aortic valve disease,who were admitted to Shiyan Taihe Hospital from January 2018 to December 2018 and underwent mitral valve replacement with preservation of the mitral subvalvular apparatus and mitral valve and aortic valve double valve replacement.There were 11 cases with preservation of the subvalvular apparatus of the full valves,35 cases with preservation of the subvalvular structure of the posterior valve,and 22 cases with complete resection of the mitral valve and the subvalvular chordae tendineae.Echocardiography review was performed 6 months after operation,and cardiac function indexes such as left atrial end-diastolic diameter,left ventricular end-diastolic transverse diameter,left ventricular ejection fraction,left ventricular short-axis shortening rate,left ventricular inflow tract and outflow tract,valve function,and paravalvular healing were compared among the three groups.Complications within 6 months after surgery were recorded.RESULTS AND CONCLUSION:The cardiopulmonary bypass time,blocking time,ICU stay time,and postoperative hospital stay in the full-valve subvalvular apparatus preservation group and the posterior subvalvular apparatus preservation group were all lower than those in the mitral valve and subvalvular chordae tendineectomy group(P<0.05).There were no significant differences in the levels of cardiac function indexes such as left atrial end-diastolic diameter,left ventricular end-diastolic transverse diameter,left ventricular ejection fraction,and left ventricular short-axis shortening rate among the three groups(
作者
原野
刘涛
刘华
Yuan Ye;Liu Tao;Liu Hua(Department of Thoracic and Cardiovascular Surgery,Taihe Hospital,Shiyan 442000,Hubei Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第20期3242-3246,共5页
Chinese Journal of Tissue Engineering Research
基金
湖北省自然科学基金项目(2019CFB407)。
关键词
二尖瓣瓣下结构
瓣膜置换
心功能
并发症
左室射血分数
mitral subvalvular apparatus
valve replacement
cardiac function
complication
left ventricular ejection fraction
