合并巨大左心室的双瓣膜关闭不全手术疗效分析

Efficacy of surgical treatment for mitral and aortic regurgitation combined with enlarged left ventricle

  • 摘要: 目的 研究合并巨大左心室的二尖瓣、主动脉瓣关闭不全患者行外科手术治疗后的中远期生存及心脏结构和功能变化。 方法 自2000年1月- 2012年12月,本院完成合并巨大左心室的二尖瓣、主动脉瓣关闭不全手术共计41例,其中男性35例,女性6例,年龄22 ~ 74(46.0±12.9)岁。术前心功能分级:纽约心脏病协会(New York Heart Association,NYHA)分级Ⅰ级2例,NYHA Ⅱ级7例,NYHA Ⅲ级23例,NYHA Ⅳ级9例。病程0.5 ~ 40(17.6±12.1)年。超声心动图示左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)为65.0 ~ 99.0(75.9±9.2) mm,左心室收缩末期内径(left ventricular end systolic diameter,LVESD)为40.0 ~ 76.0(52.1±10.2) mm,射血分数(ejection fraction,EF)为23.0% ~70.0%(51.1±10.9)%。 结果 41例中,围术期死亡1例(2.43%),与术前相比,术后2周心脏超声示左心室舒张末期内径减小为(60.8±9.9) mm (P< 0.05)。至2014年12月,32例(80%)得到随访,随访时间23 ~ 180(95.9±47.3)个月,存活30例(93.75%),5例心功能Ⅰ级,19例心功能Ⅱ级,4例心脏功能Ⅲ级,2例心功能Ⅳ级。随访期间死亡2例(6.7%),失访8例(20%)。因心脏原因死亡者1例,为慢性心功能不全。非心脏原因死亡者为脑卒中。存活患者LVEDD进一步减小,达(52.8±8.7)mm,与术后围术期LVEDD相比有明显缩小(P< 0.05)。 结论 对于合并巨大左心室的二尖瓣、主动脉瓣关闭不全患者,外科手术可改善左心室功能并使左心室进一步缩小。

     

    Abstract: Objective To study the medium- and long- term survival and cardiac structure and function of patients with mitral and aortic regurgitation combined with severely enlarged left ventricle (LV) after surgical treatment. Methods From January 2000 to December 2012, 41 patients (35 males and 6 females) with a mean age of (46.0±12.9) years, had undergone double valve surgery at Chinese PLA General Hospital. All patients had severely or moderately mitral and aortic valve regurgitation with left ventricular end diastole diameter (LVEDD) ≥65mm. 2 cases were in NYHA functional class Ⅰ, 7 cases in NYHA functional class Ⅱ, 23 cases in class Ⅲ and 9 cases in class Ⅳ. The mean clinical course was (17.6±12.1) years (range, 0.5 - 40 years). Echocardiogram (UCG)showed LVEDD was (75.9±9.2) mm (range, 65.0 - 99.0 mm), LVESD was (52.1±10.2) mm (range, 40.0 - 76.0 mm), ejective fraction (EF) was (51.1±10.9)% (range, 23.0% - 70.0%). Results One out of 41 cases died in the peri-operative period accounting for a mortality rate of 2.43%. Two weeks after surgery, the echocardiogram showed a reduction of LVEDD [(75.9±9.1) mm vs.(60.8±9.9) mm, P< 0.05]. Follow-up was completed in 32 cases (80%), the mean follow up term was (95.9±47.3) months (range,23 - 180 months). 30 cases were alive with a survival rate of 93.75%. 5 out of 32 cases was in class Ⅰ(NYHA), 19 cases in class Ⅱ,4 cases in class Ⅲ, 2 cases in class Ⅳ. 2 cases were dead during follow-up with a ratio of 6.7%, 8 cases were out of correspondence with a ratio of 20%. 1 case was dead due to cardiac events, and the main cardiac event was chronic cardiac failure. The non-cardiac event was cerebral infarction. Compared with peri-operative period, all alive cases showed further decrease of LVEDD at late control[(60.8±9.9) mmvs (52.8±8.7) mm, P< 0.05)]. Conclusion Surgery is an effective method for patients with mitral and aortic regurgitation combined with severely dilated left ventricles, and it can retard severe left ventricle dilation.

     

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