【摘要】：目的探討人工腱索在風(fēng)濕性二尖瓣狹窄老年患者二尖瓣置換術(shù)(MVR)中的臨床效果。方法回顧性分析129例風(fēng)濕性二尖瓣狹窄、瓣膜鈣化及風(fēng)濕性二尖瓣狹窄為主伴閉鎖不全MVR患者的臨床資料,其中傳統(tǒng)切除全部瓣膜及瓣下結(jié)構(gòu)(A組)55例,切除全部瓣膜后植入人工腱索組(B組)74例,分析比較兩組患者術(shù)后早期死亡率、左心室大小與功能、術(shù)后低心排綜合征、術(shù)后并發(fā)癥。結(jié)果 B組無圍術(shù)期死亡;A組術(shù)后早期死亡3例(5.4%),1例死于左室破裂,1例死于反復(fù)室顫,1例死于嚴(yán)重低心排,術(shù)后6、12個月心臟超聲隨訪結(jié)果顯示B組術(shù)后左心室射血分?jǐn)?shù)(LVEF)、左心室舒張末期內(nèi)徑(LVEDD)、左心室收縮末期內(nèi)徑(LVESD)比A組有明顯改善,LVEF和LVESD的改善差異顯著(P0.05),心功能、術(shù)后低心排綜合征、術(shù)后并發(fā)癥B組均優(yōu)于A組。結(jié)論植入人工腱索可保留乳頭肌及瓣下結(jié)構(gòu)的功能,有利于維持左室形態(tài)及左心功能的恢復(fù),減少術(shù)后并發(fā)癥,遠(yuǎn)期療效好。
[Abstract]:Objective to investigate the clinical effect of artificial chordae tendineae in mitral valve replacement (MVR) in elderly patients with rheumatic mitral stenosis. Methods the clinical data of 129 patients with rheumatic mitral stenosis, valve calcification and rheumatic mitral stenosis complicated with atresia MVR were analyzed retrospectively. there were 55 patients with traditional valvectomy and subvalvular structure (group A) and 74 patients with artificial tendon cord after valvectomy (group B). The early postoperative mortality, left ventricular size and function, postoperative low cardiac output syndrome and postoperative complications were analyzed and compared between the two groups. Results there was no perioperative death in group B. In group A, 3 cases (5.4%) died early after operation, 1 case died of left ventricular rupture, 1 case died of recurrent ventricular fibrillation, 1 case died of severe low cardiac output. The results of ultrasound follow-up at 6 months after operation showed that the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVESD) in group B was significantly better than that in group A, and the improvement of LVEF and LVESD was significant (P 0.05), and the improvement of left ventricular end systolic diameter in group B was significantly higher than that in group A. the left ventricular end diastolic diameter in group B was significantly better than that in group A. the improvement of left ventricular end diastolic diameter in group B was significantly higher than that in group A. Postoperative low cardiac output syndrome and postoperative complications in group B were better than those in group A. Conclusion the implantation of artificial chordae tendineae can preserve the function of papillary muscle and subvalvular structure, which is beneficial to maintain the recovery of left ventricular morphology and left ventricular function, reduce postoperative complications, and has good long-term effect.
【作者單位】： 南昌大學(xué)江西醫(yī)學(xué)院;南昌大學(xué)第二附屬醫(yī)院心胸外科;
【基金】：國家自然科學(xué)基金項目(81260054) 江西省自然科學(xué)基金項目(20122BAB205001) 江西省教育廳青年基金項目(GJJ13045)
【分類號】：R654.2

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