中国组织工程研究

中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (5): 705-711.doi: 10.3969/j.issn.2095-4344.2014.05.009

• 心肺移植 heart-lung transplantation • 上一篇    下一篇

人工腱索移植和马鞍环环缩修复退行性二尖瓣关闭不全

韩劲松，王辉山，尹宗涛，韩宏光，宋恒昌   

  1. 解放军沈阳军区总医院心血管外科，辽宁省沈阳市  110016
  • 修回日期:2013-11-15 出版日期:2014-01-29 发布日期:2014-01-29
  • 通讯作者: 王辉山，博士，主任医师，教授，博士生导师，解放军沈阳军区总医院心血管外科，辽宁省沈阳市 110016
  • 作者简介:韩劲松，男，1976年生，辽宁省鞍山市人，汉族，解放军第四军医大学和解放军沈阳军区总医院联合培养在读博士研究生，副主任医师，主要从事心肌保护、瓣膜外科、心房颤动、成人先天性心脏病的临床和基础研究。

Artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation

Han Jin-song, Wang Hui-shan, Yin Zong-tao, Han Hong-guang, Song Heng-chang   

  1. Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command, Shenyang 110016, Liaoning Province, China
  • Revised:2013-11-15 Online:2014-01-29 Published:2014-01-29
  • Contact: Wang Hui-shan, M.D., Chief physician, Professor, Doctoral supervisor, Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command, Shenyang 110016, Liaoning Province, China
  • About author:Han Jin-song, Studying for doctorate, Associate chief physician, Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command, Shenyang 110016, Liaoning Province, China

PDF

585

被引次数

9

摘要：

背景：人工腱索移植是二尖瓣成形的难点，瓣环环缩也是二尖瓣成形术式中的关键步骤之一，而目前国内相关此类治疗方法的安全性、有效性和中期疗效的较大样本报道较少。

目的：总结二尖瓣人工腱索移植和马鞍环环缩技术治疗退行性二尖瓣关闭不全的有效性和安全性。
方法：2009年1月至2013年5月间解放军沈阳军区总医院心血管外科应用人工腱索移植和马鞍环环缩技术治疗退行性二尖瓣关闭不全患者85例。用Gore-Tex缝线作为人工腱索，马鞍环用SJMTM刚性鞍形成形环。共行人工腱索移植41例、人工腱索移植+后叶楔形切除21例、人工腱索移植+后叶楔形切除+Sliding技术23例。均行人工瓣环环缩术。
结果与结论：治疗后随访78例，随访率为 91.7%(78/85)。随访时间为6个月-4年。78例中，1例于治疗后13个月死于脑梗死，1例死于交通事故，余76例均存活。NYHA心功能分级Ⅰ级59例，Ⅱ级17例。复查心脏彩超示微量及以下反流67例，轻度反流9例。超声心动图显示左心房直径明显减少(P < 0.05或P < 0.01)，左心室舒张末期内径明显减少(P < 0.05或P < 0.01)，左心室收缩末期内径明显减少(P < 0.05或P < 0.01)，反流速面积/左房面积明显减少(P < 0.05或P < 0.01)，肺动脉平均压明显降低(P < 0.05或P < 0.01)，射血分数明显增加(P < 0.05或P < 0.01)。未出现二尖瓣收缩期前向运动现象(SAM征)。并发症情况：治疗后出现窦性心动过缓12例，阵发性室上性心动过速25例。1例治疗前伴快-慢综合征患者，治疗后安装永久起搏器。1例治疗后1周出现延迟性心包填塞，经心包穿刺置管引流后治愈。无成形环断裂或撕脱、无溶血、左室流出道梗塞、人工腱索断裂或劈裂发生。无再次手术行瓣膜置换患者。结果可见二尖瓣人工腱索移植和马鞍环环缩治疗退行性二尖瓣关闭不全安全、有效，近中期疗效满意。


中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程


全文链接：

关键词: 实验动物, 组织构建, 退行性病变, 二尖瓣成形术, 人工腱索, 人工瓣环

Abstract:

BACKGROUND: Artificial chordae transplantation and saddle ring annuloplasty are the key steps in mitral valvuloplasty. However, there are no large-size studies addressing the safety, validity and efficacy of these treatments in China.

OBJECTIVE: To summarize the efficacy and safety of artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation.
METHODS: Eighty-five patients with degenerative mitral regurgitation underwent mitral valve repair with artificial chordae (Gore-Tex sutures) transplantation and saddle ring (SJMTM rigid saddle-shaped) annuloplasty from January 2009 to May 2013 in General Hospital of Shenyang Area Military Command, China. Operative technique included simple artificial chordae transplantation in 41 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 22 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet and sliding technique in 23 cases. All cases received saddle ring annuloplasty.

RESULTS AND CONCLUSION: Follow-up after treatment was done among 78 patients for 6 months to 4 years, with a follow-up rate of 91.7% (78/85). Among the 78 cases, one case died of cerebral infarction after 13 months, one died from accident, and the remaining 76 were alive. According to the evaluation of cardiac function (NYHA), 59 cases were in grade I and 17 cases were in grade II. Color ultrasound displayed that, no regurgitation was found in 67 cases, and mild regurgitation in 9 cases. The echocardiography showed that postoperative left atrium diameter (P < 0.05 or P < 0.01), left ventricular end-diastolic diameter (P < 0.05 or P < 0.01), left ventricular end-systolic diameter (P < 0.05 or P < 0.01), and the ratio of regurgitation beam area and left atrial area (P < 0.05 or P < 0.01), mean pulmonary artery pressure (P < 0.05 or P < 0.01) were significantly decreased compared with that before operation. Ejection fraction was significantly increased after operation (P < 0.05 or P < 0.01). No systolic anterior motion occurred. The postoperative complications included sinus bradycardia in 12 cases and paroxysmal supraventricular tachycardia in 25 cases, late cardiac tamponade in 1 case at 1 week postoperatively, and pacemarker implantation in 1 case (who exhibited bradycardia-tachycardia syndrome before operation). There was no ring rupture, ring avulsion, hemolysis, left ventricular outflow tract infarction and artificial chordae rupture or splitting. No cases needed reoperation on valve replacement. Application of artificial chordae transplantation and saddle ring annuloplasty is a safe and effective means for treating degenerative mitral regurgitation, with excellent midterm outcomes.



中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程


全文链接：

Key words:  transplantation, mitral valve regurgitation, mitral valve annuloplasty, chordae tendineae

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