22例保留前瓣叶二尖瓣膜置换术疗效观察

22例保留前瓣叶二尖瓣膜置换术疗效观察 [摘要] 目的,评估二尖瓣置换术中保留前瓣叶及其腱索对左心室功能的影响。方法,48例患者均在体外循环下进行二尖瓣置换手术,其中22例保留了二尖瓣前叶及其腱索,观察组,,26例未保留瓣叶及其腱索,对照组,。采用超声心动图评估测量两组患者术前和术后1个月左心室舒张末容积,LVEDV,、左心室收缩末容积,LVESV,和左心室射血分数,LVEF,等变化。结果,观察组无手术早期死亡病例,对照组手术早期死亡1例,3.8%, 1/26,,超声心动图显示,两组LVEDV、LVESV均较术前明显缩小,P 在二尖瓣置换手术中保留腱索虽然最终的益处尚不明确,但是有可能改善临床预后已经得到了广泛的认可[1-2]。然而,目前大多数外科医生仅仅保留带腱索的后瓣,主要原因是保留前瓣叶及腱索可能存在潜在的并发症,如,妨碍人工瓣膜机械工作,左室流出道梗塞等[3-4]。为此国内外有学者做了大量的临床研究工作,提出了许多将前叶及腱索缝合在二尖瓣环上的手术方法[4-7]。而本文观察组所采用的手术 1 方法具有安全、可重复以及容易掌握的特点,该观察结果也 为二尖瓣置换术中保留前瓣及其腱索提供了广泛的应用前 景。 [参考文献] [1]Yun KI, Sintek CF, Miller DC, et al. Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement:effects on left ventricular volume and function[J]. J Thorac Cardiovasc Surg,2002,123:707-714. [2]Talwar S, Jayanthkumar HV, Kumar AS. Chordal preservation during mitral valve replacement:basis,techniques and results[J]. Ind J Thorac Cardiovasc Surg,2005,21:45-52. [3]Thomson LE, Chen X, Greaves SC. Entrapment of mitral chordal apparatus causing early postoperative dysfunction of a St.Jude mitral prosthesis[J].J Am Soc Echocardiogr,2002,15:843-844. [4]Sasaki H, Ihashi K. Chordal-sparing mitral valve replacement: pitfalls and techniques to prevent complications [J]. Eur J Cardiothorac Surg,2003,24:650-652. [5]Rafael GF, Lgnacio R, Vanesa E, et al. Posterior transposition of anterior leaflet for complete chordal 2 preservation [J]. European Journal of Cardio-thoracic Surgery,2007,31:550-551. [6]Chowdhury UK, Kumar AS, Airan B, et al. Mitral valve replacement with and without chordal preservation in a rheumatic population: serial echocardiographic assessment of left ventricular size and function[J].Ann Thorac Surg,2005,79:1926-1933. [7]Kuralay E, Demirkilic U, Gunay C, et al. Mitral valve replacement with bileaflet preservation: a modified technique [J]. Eur J Cardiothorac Surg,2002,22:630-632. ,收稿日期,2011-05-10, 3