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[1]葉永火 謝 琦 竇 志.綜合性二尖瓣修復(fù)技術(shù)在風(fēng)濕性二尖瓣病變中的應(yīng)用(附16例報(bào)告)[J].福建醫(yī)藥雜志,2019,41(06):5-7.
　YE Yonghuo,XIE Qi,DOU Zhi..Application of comprehensive mitral valve repair technique in rheumatic mitral valve disease[J].FUJIAN MEDICAL JOURNAL,2019,41(06):5-7.
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綜合性二尖瓣修復(fù)技術(shù)在風(fēng)濕性二尖瓣病變中的應(yīng)用(附16例報(bào)告)()
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《福建醫(yī)藥雜志》[ISSN:1002-2600/CN:35-1071/R]

卷:
41
期數(shù):
2019年06期
頁碼:
5-7
欄目:
臨床研究
出版日期:
2019-12-25

文章信息/Info

Title:
Application of comprehensive mitral valve repair technique in rheumatic mitral valve disease
文章編號:
1002-2600(2019)06-0005-03
作者:
葉永火 謝 琦1 竇 志
福建醫(yī)科大學(xué)省立臨床醫(yī)學(xué)院 福建省立醫(yī)院心血管外科(福州 350001)
Author(s):
YE Yonghuo; XIE Qi; DOU Zhi.
Department of Cardiovascular Surgery,Fujian Provincial Hospital,Provincial Clinical Medical College of Fujian Medical University, Fuzhou,Fujian 350001, China
關(guān)鍵詞:
綜合性二尖瓣修復(fù)技術(shù);  風(fēng)濕性;  二尖瓣病變
Keywords:
comprehensive mitral valve repair technique;  rheumatism;  mitral valve disease
分類號:
R654.2
文獻(xiàn)標(biāo)志碼:
B
摘要:
目的 總結(jié)風(fēng)濕性二尖瓣病變患者行二尖瓣修復(fù)手術(shù)的臨床經(jīng)驗(yàn),分析其手術(shù)適應(yīng)證及早期療效。方法 回顧性分析2014年9月至2018年9月福建省立醫(yī)院心外科同一組醫(yī)生采用二尖瓣成形術(shù)治療16例風(fēng)濕性二尖瓣病變患者的臨床資料,其中男3例,女13例; 年齡36～68(47.8±9.1)歲; 單純狹窄者7例,狹窄合并關(guān)閉不全9例,合并持續(xù)性心房顫動6例,左房血栓4例,三尖瓣關(guān)閉不全3例; 術(shù)前心功能Ⅲ級11例,Ⅱ級5例。根據(jù)二尖瓣瓣膜病變類型選擇不同修復(fù)方法。術(shù)后對患者進(jìn)行隨訪,比較手術(shù)前后左心室舒張末期內(nèi)徑(LVEDD)、左心房收縮末期直徑(LAESD)、射血分?jǐn)?shù)(EF)、二尖瓣口最大開口面積的變化、二尖瓣跨瓣壓差、二尖瓣反流、心功能變化情況。結(jié)果 術(shù)后NYHA分級全部恢復(fù)為Ⅰ級。術(shù)后LAESD、LVEDD、EF和術(shù)前相比,差異均無統(tǒng)計(jì)學(xué)意義(P>0.05)。術(shù)后二尖瓣口最大開口面積為(2.21±0.43)cm2,二尖瓣跨瓣壓差(8.93±2.30)mm Hg,與術(shù)前比較,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。術(shù)后二尖瓣反流輕微11例,輕度反流4例,輕中度反流1例。6例房顫射頻消融術(shù)后,4例維持竇性心律,1例房顫復(fù)發(fā),1例于術(shù)后3年因高度傳導(dǎo)阻滯行永久起搏器安置術(shù)。結(jié)論 對于早、中期病理改變的風(fēng)濕性二尖瓣病變,綜合性二尖瓣修復(fù)技術(shù)可以取得早期的良好療效。
Abstract:
Objective To summarize the clinical experience of mitral valve repair in patients with rheumatic mitral valve disease, and to analyze its surgical indications and early curative effect.Methods The clinical data of 16 patients with rheumatic mitral valve disease treated with mitral valvuloplasty by the same group of doctors in Fujian Provincial Hospital from September 2014 to September 2018 were analyzed retrospectively, including 3 males and 13 females.The age was 36-68(47.8±9.1)years.There were 6 cases of persistent atrial fibrillation, 4 cases of left atrial thrombus, 3 cases of tricuspid insufficiency, 11 cases of preoperative cardiac function Ⅲ and 5 cases of preoperative cardiac function Ⅱ.Different repair methods were selected according to the type of mitral valvular disease.The patients were followed up after operation.The changes of left ventricular end-diastolic diameter(LVEDD), left atrial end-systolic diameter(LAESD), ejection fraction(EF), mitral valve orifice maximum opening area, mitral valve transvalvular pressure difference, mitral regurgitation and cardiac function before and after operation were compared.Results All the NYHA grades recovered to gradeⅠafter operation.There was no significant difference in LAESD, LVEDD and EF between preoperation and postoperation(P>0.05).The maximum opening area of mitral valve orifice was(2.21±0.43)cm2, and the mitral valve transvalvular pressure difference was(8.93±2.30)mm Hg after operation,and the differences were statistically significant(P<0.05).There were 11 cases of mild mitral regurgitation, 4 cases of mild regurgitation and 1 case of mild to moderate mitral regurgitation.After radiofrequency ablation of atrial fibrillation, sinus rhythm was maintained in four cases, atrial fibrillation recurred in one case, and permanent pacemaker placement was performed in one case due to high conduction block three years after operation.Conclusion For rheumatic mitral valve disease with early or middle pathological changes, comprehensive mitral valve repair technique can achieve early and good results.

參考文獻(xiàn)/References:

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備注/Memo

備注/Memo:
1 通信作者,Email:[email protected]
更新日期/Last Update: 2019-12-25