CAJ | 학술논문

目的总结采用人工腱索线圈技术治疗二尖瓣前叶脱垂的经验.方法 2008年1月至2009年8月,8例二尖瓣前叶脱垂病人中男5例,女3例;年龄28～68岁,平均(56.0±8.9)岁.心功能(NYHA)Ⅱ级2例,Ⅲ级6例.二尖瓣前叶腱索断裂7例(其中腱索断裂合并延长2例),腱索延长1例.A1区域脱垂3例,A2 区脱垂2例,A2合并A3区脱垂3例;合并二尖瓣后叶腱索断裂2例,1例合并三房心.左室舒张末直径53～62 mm,平均(57.2±3.8)mm,射血分数(EF)0.60～0.68,平均0.63±0.02.心胸比率0.52±0.17.术中采用测量器测量腱索长度,并在测量器上制作人工腱索线圈,固定在乳头肌和瓣叶游离缘.结果手手术死亡.1例男性病人术后第2天出现血红蛋白尿,经过碱化尿液、利尿、激素等治疗后改善.出院前复查超声心动图显示少量反流1例,微量反流7例.术后左室舒张末直径42～51 nm,平均(47.1±2.2)mm,较术前明显改善.出院后常规抗凝治疗3个月.术后随访1～19个月,平均(8.2±4.3)个月,少量反流1例,无或微量反流7例.心功能Ⅰ级6例,Ⅱ级2例,较术前明显改善.结论人工腱索线圈治疗二尖瓣前叶脱垂近期效果确切、容易复制.
목적 총결채용인공건색선권기술치료이첨판전협탈수적경험.방법 2008년1월지2009년8월,8례이첨판전협탈수병인중남5례,녀3례;년령28～68세,평균(56.0±8.9)세.심공능(NYHA)Ⅱ급2례,Ⅲ급6례.이첨판전협건색단렬7례(기중건색단렬합병연장2례),건색연장1례.A1구역탈수3례,A2 구탈수2례,A2합병A3구탈수3례;합병이첨판후협건색단렬2례,1례합병삼방심.좌실서장말직경53～62 mm,평균(57.2±3.8)mm,사혈분수(EF)0.60～0.68,평균0.63±0.02.심흉비솔0.52±0.17.술중채용측량기측량건색장도,병재측량기상제작인공건색선권,고정재유두기화판협유리연.결과 수수술사망.1례남성병인술후제2천출현혈홍단백뇨,경과감화뇨액、이뇨、격소등치료후개선.출원전복사초성심동도현시소량반류1례,미량반류7례.술후좌실서장말직경42～51 nm,평균(47.1±2.2)mm,교술전명현개선.출원후상규항응치료3개월.술후수방1～19개월,평균(8.2±4.3)개월,소량반류1례,무혹미량반류7례.심공능Ⅰ급6례,Ⅱ급2례,교술전명현개선.결론 인공건색선권치료이첨판전협탈수근기효과학절、용역복제.
Objective To summarize the clinical experience for treating anterior mitral leaflet prolapse with an artificial chordal loop. Methods From January 2008 to August 2009, pre-measured ePTFE loops were used to treat anterior leaflet prolapse in 8 patients, 5 males and 3 females, aged from 28 to 68 ( average 56.0 ± 8.9 ) years. The heart function (NYHA) was class Ⅱ in 2 patients and class Ⅲ in 6. Echocardiography showed chordal rupture in 7 patients, 2 with chordal rupture and elongation and pure chordal elongation in 1. There were 3 patients with A1 segment prolapse of anterior mitral leaflet, 2 with A2 segment prolapse, 3 with both A2 and A3 segments prolepses by Carpentier standardization. There were 2 patients with posterior leaflet chordal rupture in P2 and P3 segment, 1 with cor triatrium. Left ventricular end diastolic diameter (LVEDD) was 53 - 62 mm [average ( 57.2±3.8 ) mm]. Ejection fraction (EF) was 0.60 - 0. 68 ( average 0.63 ± 0.02). Heart-thoracic ratio was 0. 52 ± 0. 17. We measured the normal chordal using both a caliber and by echocardiography ( for comparison after operation). The artificial chordal loops was constructed on the caliber using ePTFE suture, and then fixed the loop to the papillary muscle and the free edge of the anterior leaflet. Results There was no operation death. Hemolysis after 2 days of operation in 1 patient was amended by alkalinization, diuresis and hormone treatment. Pre-discharge transthoracic echocardiography showed mild regurgitation in 1patient, trivial regurgitation in 7. LVEDD were 42 -51mm [average (47. 1 ±2.2) mm] significantly decreased than that of pre-operation. Following parameters were measured and compared with pre-operation: EF 0. 58 ± 0. 03 vs. 0. 63 ± 0. 02, beart function ( NYHA ) class 1.25 ± 0. 42 vs. 2.75 ± 0. 58. Normal chordal length measured by caliber was ( 21.20 ± 1.55 ) mm vs. ( 22. 10 ± 2.68 ) mm by echocardiography. Anticoagulate therapy with warfarin was for 3 months after discharge and followed-up all the patients [1 - 19 months, average (8.2 ± 4.3 ) months]. Post operative echocardiography showed mild regurgitation in 1 patient, no or trivial regurgitation in 7 patients. The heart function class was evident improved compared with pre-operation :6 patients in class Ⅰ , 2 patients in class Ⅱ. Conclusion The pre-measured ePTFE loop is reliable and reproducible confirmed by short term follow-up for treating anterior leaflet prolapse.