CAJ | 학술논문

目的分析二尖瓣关闭不全的超声分型改进与手术方式选择以及预后的关系,为二尖瓣关闭不全患者术前手术方式的选择提供新的形态学依据.方法 47例行二尖瓣重建术和41例行二尖瓣置换术患者术前采用HP Sonos 2500多功能超声仪和2.5 MHz的探头行超声检查,根据二维显像上瓣叶的对位和对合情况分为三型.I型:二尖瓣前后叶瓣尖处对位和对合均正常;I型:二尖瓣对位正常,但对合异常;Ⅲ型:二尖瓣对位和对合均异常.结果 47例成形术患者的超声显像分型示,I型占20例,Ⅱ型3例,Ⅲ型24例.术后接受超声随访的34例患者中,11例术后出现二尖瓣中、重度返流,包括1型2例和Ⅲ型9例.Ⅱ型患者的预后远不如I型和Ⅱ型(P<0.05).41例行二尖瓣置换术的患者中,噩型占31例(75.6%),其中合并腱索断裂或(和)严重瓣膜、瓣下结构受损者共占25例.结论超声分型与二尖瓣关闭不全手术方式的选择有直接关系.
목적 분석이첨판관폐불전적초성분형개진여수술방식선택이급예후적관계,위이첨판관폐불전환자술전수술방식적선택제공신적형태학의거.방법 47례행이첨판중건술화41례행이첨판치환술환자술전채용HP Sonos 2500다공능초성의화2.5 MHz적탐두행초성검사,근거이유현상상판협적대위화대합정황분위삼형.I형:이첨판전후협판첨처대위화대합균정상;I형:이첨판대위정상,단대합이상;Ⅲ형:이첨판대위화대합균이상.결과 47례성형술환자적초성현상분형시,I형점20례,Ⅱ형3례,Ⅲ형24례.술후접수초성수방적34례환자중,11례술후출현이첨판중、중도반류,포괄1형2례화Ⅲ형9례.Ⅱ형환자적예후원불여I형화Ⅱ형(P<0.05).41례행이첨판치환술적환자중,악형점31례(75.6%),기중합병건색단렬혹(화)엄중판막、판하결구수손자공점25례.결론 초성분형여이첨판관폐불전수술방식적선택유직접관계.
Objective To show the new criterion of echocardiographic classification of mitral valve insufficiency and its relationship to surgical decision making and postoperative effect.Therefore,to provided echocardiographically morphologic evidences for the preoperative decision making.Methods 88 patients with mitral insufficiency were studied by two-dimensional echocardiographic imaging.HP Sonos 2500 echocardiographic system and 2.5 MHz probe were used for data acquisition. Among them 47 patients had undergone mitral valve reconstruction and 41 patients had undergone mitral valve replacement.Three patterns of leaflet closure were found.Type I:normal apposition and coaptation;TypeⅡ:normal apposition but deficient coaptation;Type Ⅲ:abnormal apposition and deficient coaptation.Results Among the patients with mitral valve reconstruction,there were 20 cases of type I,3 cases of typeⅡand 24 cases of type Ⅲ.34 cases were followed up postoperatively.Moderate or severe mitral regurgitation were found in 1 1 patients including 2 cases of type I.9 cases of type Ⅲ.The patients of type Ⅲ had a poorer prognosis than those of type I and typeⅡ(P<0.05).On the other hand,among the patients with mitral valve replacement,31 cases belonged to type Ⅲ(75.6%)and 25 cases were found to have ruptured chordae and serious lesions of the valve and subvalvular structure.Conclusions Echocardiographic classification of mitral valve insufficiency has a direct relationship to surgical patterns.