摘要
目的探讨"缘对缘"二尖瓣成形术对术后左心室舒张功能的影响,以了解该成形方法的有效性及安全性。方法将2006年2月至2007年12月北京安贞医院收治的30例中至重度二尖瓣关闭不全患者,按手术方法不同分为两组,对照组:15例,二尖瓣后叶脱垂患者施行后叶楔形切除二尖瓣成形术;实验组:15例,前叶或双叶脱垂患者施行"缘对缘"二尖瓣成形术;所有患者均用二尖瓣成形环(Medtronic成形环)成形。用漂浮Swan-Ganz导管监测术前、术毕、术后2 h、4 h、6 h和12 h的血流动力学变化。术前和术后1周,运用脉冲多普勒、组织多普勒测定患者左心室舒张功能指标,包括术前和术后左心室舒张峰值血流速度E峰与A峰的比值(E/A),舒张期E峰血流速度与舒张早期二尖瓣环的最大运动速度的比值(E/Em),舒张早期二尖瓣环的最大运动速度与舒张晚期二尖瓣环的最大运动速度的比值(Em/Am)。结果两组患者二尖瓣成形二尖瓣瓣口面积均较本组术前明显减小(对照组3.63±1.06 cm2vs.7.18±2.41 cm2;实验组3.44±1.02 cm2vs.6.51±3.06 cm2;P<0.05),二尖瓣反流均较本组术前明显减少(对照组0.53±0.64 cm2vs.3.60±0.51 cm2;实验组0.67±0.82 cm2vs.3.40±0.63 cm2,P<0.05);但术前、术后两组间二尖瓣瓣口面积和二尖瓣反流比较差异无统计学意义(P>0.05)。实验组术后E/A、E/Em和Em/Am与术前比较差异无统计学意义(E/A 1.28±0.36 vs.1.95±1.06;E/Em 8.79±2.16 vs.8.13±3.02;Em/Am 1.39±0.38 vs.1.31±0.41;P>0.05),两组间比较差异无统计学意义(P>0.05)。实验组肺动脉楔压与对照组比较差异亦无统计学意义(13.60±4.37 mm Hg vs.12.20±3.53 mm Hg,P>0.05)。结论"缘对缘"二尖瓣成形术效果良好,对左心室舒张功能无明显影响,双孔二尖瓣具有与正常二尖瓣相似的的血流动力学特征。
Objective To investigate the effect of edge-to-edge mitral valve plasty on left ventricular diastolic function and in order to find the validity and safety of this procedure. Methods From Feb. 2006 to Dec. 2007, thirty cases with mJtral regurgitation were divided into two groups. Quadrangular resection was performed on fifteen cases with posterior proplapse in control group, and edge-to-edge mitral valve plasty was performed on fifteen cases with anterior or bileaflet proplapse in experimental group, and ring annuloplasty（Medtronic ring） was used in both groups. The hemodynamics were monitored and recorded with Swan-Ganz catheter at the time of postoperation,2 h, 4 h, 6 h and 12 h after operation. Left ventrieular diastolic function was also evaluated with echocardiography using color Doppler and tissue Doppler imaging in the patients with sinus rhythm. The ratio of the peak E velocity and A velocity （E/A）, the ratio of the early diastolic peak flow velocity to the early diastolic mitral valve annular movement velocity （E/Em）, and the ratio of early diastolic mitral valve annular movement velocity to late diastolic mitral valve annular movement velocity（Em/Am）were measured before operation and 1 week after operation respectively. Results Mitral valve area were significantly reduced at 1 week after operation compared with that before operation in both groups （control group 3.63±1.06 cm2 vs. 7.18±2.41 cm2, experimental group 3.44±1.02 cm2 vs. 6.51±3.06 cm2, P〈 0.05） ; and mitral regurgitant grade were significantly reduced at 1 week after operation in both groups as well（control group 0.53±0.64 cm2 vs. 3.60±0.51 cm2, experimental group 0.67±0.82 cm2 vs. 3.40±0. 63 cm2, P〈0.05）. However, there was no significant difference for mitral valve area and mitral regurgitant grade between two groups before and after operation（P2〉0.05）. In experimental group, there were no significant change of evaluations of E/A, E/Emand Em/Am before and after operation（E/A 1.28±0.36 vs. 1. 95±1. 06,E/Em 8. 79±2.16 vs. 8. 13±3.02, Em/Am 1.39±0.38 vs. 1. 31±0. 41,P〉0. 05）. There was no significant change of pulmonary artery wedge pressure （PAWP） before and after operation between two groups（13.60±4.37 mm Hg vs. 12.20±3.53 mm Hg, P〉0.05）. Conclusion Edge to edge mitral valve plasty technique is available and has no significant influence on left ventrieular diastolic function, and a double orifice mitral valve has similar hemodynamic change compared with a physiological mitral valve.
出处
《中国胸心血管外科临床杂志》
CAS
2009年第5期344-347,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
