二尖瓣人工瓣环成形术18例

二尖瓣人工瓣环成形术18例 Mitral valvuloplasty in 18 cases 2011-09-14 Wu Ruobin, Liu Jing, Xiao Xuejun, Zhang Jingfang [Abstract] Objective To retrospectively analyze the curative effect of mitral valvuloplasty in 18 cases. Methods there were 3 cases of rheumatic lesions, 11 cases of degenerative changes, 4 cases of congenital lesions. There were 16 cases with severe closure and 2 cases with moderate insufficiency. According to the pathological changes of mitral valve, the artificial mitral annulus was implanted after the valve flap plasty. 10 cases underwent angioplasty under transesophageal echocardiography monitoring. Results mitral regurgitation occurred in 6 cases, mild regurgitation in 9 cases, moderate reflux in 1 cases. Mitral valve replacement was performed in 2 patients. The follow-up period ranged from 7 months to 6 years, 7 months, with an average of 3.6 years, and the cardiac function was improved significantly. Conclusion mitral annular valvuloplasty for mitral valve rings is satisfactory in both short and long term clinical outcomes. Keywords mitral valvuloplasty; artificial mitral annulus; Prosthetic, ring, for, mitral, annuloplasty (Report, of, 18, cases) Wu, Ruobin, Liu, Qing, Xiao, Xuejun (Department, of, Cardiac, Surgery, Guangdong, Provincial, Cardiovascular, Institute, Guangzhou, 510080) [Abstract] Objective This article is to review the experience of prosthetic mitral annuloplasty. Methods The cause of valvular incompetence was found to be rheumatic in cases myxomatous degeneration 3, in 11 and congenital in 4. The mitral valve incompetence was graded as severe in 16 cases and moderate in All patients underwent mitral annuloplasty using 2. prosthetic mitral ring. 10 patients underwent mitral annuloplasty in use of intraoperative transeophaged echocardiography.Results The mitral valve incompetence was graded as no incompetence in 6 cases, slight in 9 and moderate in 1 after surgery. Two patients underwent mitral valve replacement. Patients were followed up for 7 months to 6 yeras and 7 months (average 3.6 years) Their. Cardiac, functions, were, improved.Conclusion, The, efficacy, of, late, mitral, annuloplasty, using,, prosthetic, ring, is, satisfactory. [Key, words] Mitral, annuloplasty, Prosthetic, mitral, ring From March 1993 to March 1999, mitral valvuloplasty was performed in 18 patients with mitral insufficiency. The follow-up reports were as follows: Data and methods Clinical data: there were 8 males and 10 females, aged 9~69 years, with an average age of (23.1 + 15.4) years in 18 cases. There were 3 cases of rheumatic heart disease, 11 cases of degenerative changes, 4 cases of congenital lesions. 2 cases complicated with aortic disease. The electrocardiogram showed 17 cases of sinus rhythm and 1 cases of atrial fibrillation. Cardiothoracic ratio ranged from 0.52 to 0.8, with an average of 0.63 + 0.09. Echocardiography showed severe mitral insufficiency in 16 cases, moderate in 2 cases, mitral regurgitation area of 6.2 to 27.32 cm2, mean (10.32 + 6.2) cm2, left ventricular end diastolic diameter 52~88 mm, mean (59.75 + 13.3) mm. Preoperative cardiac function (grade NYHA), grade III, 12 cases, grade IV, 6 cases. Anatomic features: 14 cases of mitral ligament extension and 4 cases of chordae rupture, all patients had different extent of mitral annulus enlargement. Methods: the operation was performed under general anesthesia and hypothermic cardiopulmonary bypass. The mitral valvuloplasty was performed in 11 cases and the mitral valve resection was performed in 7 cases. Then, the mitral annular valvuloplasty was performed to measure the area of the large flap, and to select the appropriate type of prosthetic ring according to the size of the large flap. 2-0 Dacron wires are used as intermittent mattress suture on the valve ring, 4~6 stitches are placed on the front side of the front lobe, and 6~8 stitches on the back leaves. The sutures are respectively carried out through the inner and outer edges of the artificial valve rings, and are inserted into artificial rings, respectively, number 28~32. Carpentier rings were used in 16 patients, and St.Jude soft rings in 2 patients. After repeated treatment, repeated injection of water into the left ventricle was performed to determine the effect of mitral valvuloplasty. Among the 10 patients in the intraoperative transesophageal echocardiography mitral valve plasty, cardiac resuscitation after transesophageal echocardiography, 5 cases without regurgitation, 4 cases of mild regurgitation, 1 cases still had severe regurgitation, immediately change the mitral valve replacement. 2 cases underwent aortic valve replacement at the same time. Result Postoperative hemolysis occurred in 1 cases, and mitral valve replacement was performed. 7~10 days after the operation, echocardiography showed no mitral regurgitation in 6 cases, mild reflux in 9 cases, moderate reflux in 1 cases. There were no deaths in this group. All patients were cured and discharged. 3 months after operation, 13 cases were followed up for 7 months to 6 years and 7 months, with an average of 3.6 years. The patients were followed up for more than 5 years and 3 cases. Cardiac function class I in 12 cases, second class in 1 cases. Echocardiography showed no regurgitation in 5 cases, mild reflux in 7 cases, moderate reflux in 1 case. The chest X-ray and echocardiogram results are shown in table. Table x, echocardiography, preoperative and postoperative results were compared (s) Cardiothoracic ratio, left ventricular end diastolic diameter (mm) mitral regurgitation area; (cm2) Preoperative 0.63 + 0.09, 59.75 + 13.3, 10.32 + 6.2 7 days after operation, 0.55 + 0.07*, 49.73 + 9.2, 2.48 + 2.31** 3 months after operation, 0.51 + 0.05**, 44.96 + 6.99*, 1.13 + 1.1** Note: compared with the preoperative apparatus * P < 0.05; **P < 0.01. discuss The main principle of applying artificial ring forming is to reduce the enlarged posterior lobe, draw the posterior lobe forward, increase the anterior and posterior lobes, and correct the incomplete closure. The advantages of artificial ring annuloplasty using: retain the opening area and the shape of the mitral valve, thus avoiding the stenosis, and the flap were folded due to valve dysfunction. The enlarged mitral valve ring was evenly narrowed to prevent the mitral annular enlargement after operation. No left ventricular outflow tract obstruction has been reported using prosthetic rings, and this is not the case in this group. A minority of mitral valvuloplasty is not successful at once, It is reported that there is still a severe mitral regurgitation after initial formation, and the treatment should be 18% to 22% [1] during the same operation. This group of 1 cases of water injection test showed no significant mitral regurgitation, however after the heart resuscitation, transesophageal echocardiography mitral valve was found on the poor, severe regurgitation, mitral valve replacement was diverted. There were 1 cases of moderate mitral regurgitation after operation. The water injection test showed good mitral valve closure, but there was no intraoperative transesophageal echocardiography, and moderate follow-up was followed up. Therefore, it is better to perform mitral valvuloplasty under transesophageal echocardiography [2]. The mitral regurgitation area decreased and the left ventricular end diastolic dimension decreased, indicating that the left ventricular systolic function and pump blood function were significantly increased. In short, artificial valve ring for treatment of mitral regurgitation, can effectively prevent and reduce the mitral regurgitation, and mitral valve opening area effective physiological changes, short-term and long-term clinical results were satisfactory. Wu Ruobin (Department of cardiac surgery, Institute of cardiovascular diseases, Guangzhou, Guangdong 510080) Liu Jing (Department of cardiac surgery, Institute of cardiovascular disease, Guangzhou, Guangdong 510080) Xiao Xuejun (Department of cardiac surgery, Institute of cardiovascular disease, Guangzhou, Guangdong 510080) Zhang Jingfang (Department of cardiac surgery, Institute of cardiovascular disease, Guangzhou, Guangdong 510080) Reference 1, Maurer, G, Sieegel, RJ, Czer, L, S., The, of, color, flow, mapping, for, intraopertive, assessment, of, use, valve, repair., Circulation, 1991, (Suppl):