人工腱索在老年二尖瓣置换术中的临床应用
发布时间：2019-07-29 13:35
【摘要】：目的探讨人工腱索在风湿性二尖瓣狭窄老年患者二尖瓣置换术(MVR)中的临床效果。方法回顾性分析129例风湿性二尖瓣狭窄、瓣膜钙化及风湿性二尖瓣狭窄为主伴闭锁不全MVR患者的临床资料,其中传统切除全部瓣膜及瓣下结构(A组)55例,切除全部瓣膜后植入人工腱索组(B组)74例,分析比较两组患者术后早期死亡率、左心室大小与功能、术后低心排综合征、术后并发症。结果 B组无围术期死亡;A组术后早期死亡3例(5.4%),1例死于左室破裂,1例死于反复室颤,1例死于严重低心排,术后6、12个月心脏超声随访结果显示B组术后左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)比A组有明显改善,LVEF和LVESD的改善差异显著(P0.05),心功能、术后低心排综合征、术后并发症B组均优于A组。结论植入人工腱索可保留乳头肌及瓣下结构的功能,有利于维持左室形态及左心功能的恢复,减少术后并发症,远期疗效好。
[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.
【作者单位】： 南昌大学江西医学院;南昌大学第二附属医院心胸外科;
【基金】：国家自然科学基金项目(81260054) 江西省自然科学基金项目(20122BAB205001) 江西省教育厅青年基金项目(GJJ13045)
【分类号】：R654.2
[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.
【作者单位】： 南昌大学江西医学院;南昌大学第二附属医院心胸外科;
【基金】：国家自然科学基金项目(81260054) 江西省自然科学基金项目(20122BAB205001) 江西省教育厅青年基金项目(GJJ13045)
【分类号】：R654.2
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