CAJ | 학술논문

目的总结自体心包片加宽瓣膜面积的二尖瓣成形术的临床疗效,探讨其手术技巧和适应证.方法 2004年7月至2008年6月治疗45例单纯二尖瓣瓣膜病变病人,二尖瓣狭窄10例,关闭不全35例,其中先天性8例,风湿性21例,退行性7例,感染性心内膜炎9例.应用自体心包片行后瓣叶加宽14例,前瓣叶加宽8例,前、后瓣叶都加宽23例;镜式成形12例;人工腱索12例,腱索转移6例,乳头肌开窗4例.全部病例均瓣环成形,应用Duran环16例,Carpentier环29例.并比较手术前、后心功能变化.结果无死亡病例.1例风湿性瓣膜闭合不好,术中改瓣膜置换术.术中食管超声示二尖瓣无反流38例,少量反流6例;二尖瓣有效瓣口面积平均(2.8±0.6)cm~2,跨瓣压差平均(6.21 ±1.34)mm Hg(1 mm Hg=0.133 kPa).平均随访(18.0±2.1)个月.复查超声示二尖瓣无反流35例,少量反流9例.有效瓣12面积平均(2.5±0.8)cm~2,跨瓣压差平均(7.21±0.45)mmHg,均无需再手术.术前、术后左心室舒张末期内径(56±6)mm对(48±7)mm,P<0.05;射血分数(0.45±0.23)对(0.51±0.24),P<0.05;左心房内径(62±23)mm对(50±11)mm,P<0.05.心功能明显改善,瓣膜功能好.结论自体心包片加宽瓣膜面积补偿瓣叶和(或)腱索的短缩,增加瓣叶活动,增加瓣膜闭合面积,结合瓣环成形,临床疗效肯定.手术操作简单,且自体心包相容性好,术后无需抗凝.
목적 총결자체심포편가관판막면적적이첨판성형술적림상료효,탐토기수술기교화괄응증.방법 2004년7월지2008년6월치료45례단순이첨판판막병변병인,이첨판협착10례,관폐불전35례,기중선천성8례,풍습성21례,퇴행성7례,감염성심내막염9례.응용자체심포편행후판협가관14례,전판협가관8례,전、후판협도가관23례;경식성형12례;인공건색12례,건색전이6례,유두기개창4례.전부병례균판배성형,응용Duran배16례,Carpentier배29례.병비교수술전、후심공능변화.결과 무사망병례.1례풍습성판막폐합불호,술중개판막치환술.술중식관초성시이첨판무반류38례,소량반류6례;이첨판유효판구면적평균(2.8±0.6)cm~2,과판압차평균(6.21 ±1.34)mm Hg(1 mm Hg=0.133 kPa).평균수방(18.0±2.1)개월.복사초성시이첨판무반류35례,소량반류9례.유효판12면적평균(2.5±0.8)cm~2,과판압차평균(7.21±0.45)mmHg,균무수재수술.술전、술후좌심실서장말기내경(56±6)mm대(48±7)mm,P<0.05;사혈분수(0.45±0.23)대(0.51±0.24),P<0.05;좌심방내경(62±23)mm대(50±11)mm,P<0.05.심공능명현개선,판막공능호.결론 자체심포편가관판막면적보상판협화(혹)건색적단축,증가판협활동,증가판막폐합면적,결합판배성형,림상료효긍정.수술조작간단,차자체심포상용성호,술후무수항응.
Objective To evaluate the clinic effect of leaflet enlargement with autologous pericardium in repairing mitral valve disease and to describe the technique and discuss its indications. Methods Between July 2004 and June 2008, 45 pa-tients with isolated mitral valve disease, included stenosis in 10 and regurgitation in 35. The causes were congenital heart dis-ease in 8, rheumatic in 21, degenerative in 7 and endecarditis in 9. The procedures were: posterior leaflet enlargement with autologuus pericardium in 14, anterior leaflet enlargement in 8, both anterior and posterior leaflet enlargement in 23. In addi-tion, eye to eye technique was in 12, artificial chordal in 12, chordal transfer in 6, papillary muscle vepesitioning in 4. Mitral anuuloplasty was performed in all cases. Before and after surgery, cardiac function parameters were compared. Results No operative deaths occurred. One case wastransfered to mitral valve replacement due to regurgation, lntraoperative transesophageal echocardiography showed no mitral regurgitation in 38 and small regurgitation in 6 cases. The mean mitral valve effective orifice area(MVEOA) was (2.8±0.6) cm~2, with a mean gradient pressure of (6.21±1.34) mm Hg after operation. The mean followed up was ( 18.0±2.1 ) months. Echocardiography study showed that no mitral regurgitation in 35 cases, slight regurgi-tation in 9, mean mitral effective orifice area was (2.5±0. 8 ) cm~2, mean gradient pressure of (7.21±0. 45 ) mm Hg, no one need reoperation. Postoperative cardiac functions were significantly improved: the average left ventricular end-diastolic diameter (LVEDD) was (48±7) mm [ preoperative (56±6) nun, P <0.05], ejection fraction (EF) was 0.51～0.24( preoperative 0.45± 0.23, P < 0.05 ), the average left atrium diameter ( LA ) was ( 50±11 ) mm [ preoperative ( 62±23 ) mm, P <0. 05 ]. The function of mitral valves was well performed. Conclusion Leaflet enlargement with autologous pericardium com-bined with mitral annuloplasty was effective in repairing of diseased mitral valve. The advantages of the procedure including simplicity, good compatibility, avoiding foreign body and no need for anticoagulation.