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|本期目录/Table of Contents|

CABG同期行左室成形术和二尖瓣成形术治疗左室室壁瘤并发二尖瓣关闭不全的效果(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第3期
页码:
346-349
栏目:
临床研究
出版日期:
2017-01-25

文章信息/Info

Title:
Mitral valve reconstruction combined with left ventricular restoration and coronary artery bypass graft for post-infarction ventricular aneurysm and mitral regurgitation
作者:
尹朝华; 吕 锋; 宋云虎; 孙寒松; 许建屏; 胡盛寿; 凤 玮
中国医学科学院、北京协和医学院心血管病研究所、阜外医院心外科，北京 100037
Author(s):
YIN Zhao-hua;  L Feng;  SONG Yun-hu;  SUN Han-song;  XU Jian-ping;  HU Sheng-shou;  FENG Wei
Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
关键词:
左心室室壁瘤; 左室成形术; 二尖瓣成形术
Keywords:
left ventricular aneurysm;  left ventricular restoration;  mitral valve repair
分类号:
R542.5
DOI:
-
文献标识码:
A
摘要:
目的 评价冠状动脉旁路移植术（CABG）同期行左室成形术和二尖瓣成形术治疗左室室壁瘤并发二尖瓣关闭不全的近远期临床效果。方法 自2000年1月~2008年12月，我院共32例患者因左室室壁瘤并发缺血性二尖瓣关闭不全同期进行左室成形术+二尖瓣成形术。左室成形术手术方式包括：线性缝合16例（50%）；心内膜环缩成形术9例（28%）；心室内环状补片成形术7例（22%）。二尖瓣成形术入路包括：左室入路20例（62%），右房-房间隔入路11例（34%），房间沟入路1例（3%）。全部患者均同期行CABG。本研究回顾性分析了上述患者手术中及围手术期的临床资料，并进行了46~175个月随访。结果 围手术期死亡1例（3%）。术后1年和5年生存率分别为97%和74%。随访期间，9%（3例）出现二尖瓣中量及以上返流，9%（3例）出现NYHA心功能III~IV级。左室成形方式及二尖瓣成形入路对远期效果无显著影响。结论 左室成形术同期行二尖瓣成形术是治疗左室室壁瘤并发二尖瓣关闭不全的有效方法，术后的近远期临床结果令人满意。
Abstract:
AIM To evaluate our experience of mitral valve repair in combination with left ventricular restoration and coronary artery bypass graft (CABG) for post-infarction ventricular aneurysm and mitral regurgitation so as to improve the clinical results for these patients. METHODS From January 2001 to December 2008, 32 consecutive patients with left ventricular aneurysm and ischemic mitral valve regurgitation underwent mitral valve repair combined with ventriculoplasty and CABG. Clinical findings were reviewed retrospectively and the duration of follow-up was 46-175 months. RESULTS Operative mortality was 3%. One-year and 5-year survival rates were, respectively, 97% and 74%. During follow-up, three patients (9%) had NYHA class III and IV and three patients (9%) had ≥2+ mitral regurgitation. The surgical technique for ventriculoplasty and the approach for mitral valve repair did not significantly affect the clinical outcomes. CONCLUSION Combined mitral and left ventricular reconstruction and coronary revascularization is effective for ischemic left ventricular aneurysm with mitral regurgitation. Short- and long-term clinical outcomes are satisfactory.

参考文献/References

[1]Go AS,Mozaffarian D,Roger VL,et al.Heart disease and stroke statistics-2013 update: a report from theAmerican Heart Association[J].Circulation,2013,127(1):e6-e245.
[2]Mickleborough LL,Carson S,Ivanov J.Repair of dyskinetic or akinetic left ventricular aneurysm: results obtained with a modified linear closure[J].J ThoracCardiovascSurg,2001,121(4):675-682.
[3]Jones RH,Velazquez EJ,Michler RE,et al.Coronary bypass surgery with or without surgical ventricular reconstruction[J].N Engl J Med,2009,360(17):1705-1717.
[4]Di Donato M,Castelvecchio S,Kukulski T,et al.Surgical ventricular restoration:left ventricular shape infl-uence on cardiac function,clinical status,and survival[J].Ann Thorac Surg,2009,87(2):455-461.
[5]Menicanti L,Di Donato M.The Dor procedure:What has changed after ?fteen years of clinical practice?[J].J ThoracCardiovasc Surg,2002,124(5):886-890.
[6]Di Donato M,Castelvecchio S,Brankovic J,et al.Effectiveness of surgical ventricular restoration in patients with dilated ischemic cardiomyopathy and unrepaired mild mitral regurgitation[J].J Thorac Cardiovasc Surg,2007,134(6):1548-1553.
[7]Menicanti L,Di Donato M,Castelvecchio S,et al.Functional ischemic mitral regurgitationin anteriorventricular remodeling:results of surgical ventricular restoration with and without mitral repair[J].Heart Fail Rev,2004,9:317-27.
[8]Mickleborough LL,Merchant N,Ivanov J,et al.Left ventricular reconstruction:early and late results[J].J Thorac Cardiovasc Surg,2004,128(1):27-37.
[9]Klein P,Braun J,Holman ER,et al.Management of mitral regurgitation during leftventricular reconstruction for ischemic heart failure[J].Eur J Cardiothorac Surg,2012,41(1):74-81.
[10]Dor V,Sabatier M,Montiglio F,et al.Endoventricularpatch reconstruction of ischemic failing ventricle.asingle center with 20 years experience.advantages of magnetic resonance imaging assessment[J].Heart Failure Reviews,2004,9(4):269-286.
[11]Levine RA,Swammenthal E.Ischemic mitral regurgitation on the threshold of a solution:from paradoxes to unifying concepts[J].Circulation,2005,112(5):745-758.
[12]Trichon BH,Felker GM,Shaw LK,et al.Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure[J].Am J Cardiol,2003,91(5):538-543.
[13]Rausch MK,Bothe W,Kvitting JP,et al.Characterization of mitral valve annular dynamics in the beating heart[J].Ann Biomed Eng,2011,39(6):1690-1702.
[14]Daimon M,Saracino G,Fukuda S,et al.Dynamic change of mitral annular geometry and motion in ischemic mitral regurgitation assessed by a computerized 3D echo method[J].Echocardiography,2010,27(9):1069-1077.
[15]Grewal J,Suri R,Mankad S,et al.Mitral annular dynamics in myxomatous valve disease:new insights with real-time 3-dimensional echocardiography[J].Circulation,2010,121(12):1423-1431.
[16]Levack MM,Jassar AS,Shang EK,et al.Three-dimensional echocardiographic analysis of mitral annular dynamics:implication for annuloplasty selection[J].Circulation,2012,126(11 Suppl 1):S183-S188.
[17]Crabtree TD,Bailey MS,Moon MR,et al.Recurrent mitral regurgitation and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation[J].Ann Thorac Surg,2008,85(5):1537-1542.
[18]Hung J,Solis J,Handschumacher MD,et al.Persistence of mitral regurgitation following ring annuloplasty:is the papillary muscle outside or inside the ring?[J].J Heart Valve Dis,2012,21(2):218-224.
[19]Veronesi F,Corsi C,Sugeng L,et al.Quantification of mitral apparatus dynamics in functional and ischemic mitral regurgitation using real-time 3-dimensional echocardiography[J].J Am Soc Echocardiogr,2008,21(4):347-354.
[20]Fattouch K,Castrovinci S,Murana G,et al.Relocation of papillary muscles for ischemic mitral valve regurgitation: the role of three-dimensional transesophageal echocardiography[J].Innovations(iPhila),2014,9(1):54-59.

备注/Memo

备注/Memo:
收稿日期: 2016-02-13.通讯作者：凤玮，主任医师，主要从事心血管外科临床研究 Email：fengwei@fuwai.com 作者简介：尹朝华，副主任医师，博士 Email：cams_yinzhaohua@sina.com
更新日期/Last Update: 2017-02-20