Chinese Journal of Tissue Engineering Research ›› 2014, Vol. 18 ›› Issue (5): 705-711.doi: 10.3969/j.issn.2095-4344.2014.05.009
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Han Jin-song, Wang Hui-shan, Yin Zong-tao, Han Hong-guang, Song Heng-chang
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
CLC Number:
Han Jin-song, Wang Hui-shan, Yin Zong-tao, Han Hong-guang, Song Heng-chang. Artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(5): 705-711.
2.1 治疗早期情况 85例患者中行人工腱索移植41例、行人工腱索移植+后叶楔形切除21例、行人工腱索移植+后叶楔形切除+滑行(Sliding)技术23例。每例使用Gore-Tex人工腱索为1-4根。对85例患者均行二尖瓣人工瓣环环缩技术,均使用SJMTM刚性鞍形成形环进行环缩术。在85例患者中使用30号环64例、使用32号环21例。同期行三尖瓣成形术40例(Kay成形术5例、Edwards MC3 三尖瓣瓣环环缩术35例)。平均体外循环时间为62-105 min,平均为(72±11) min;主动脉阻断时间为39-80 min,平均为(55±8) min。住院时间为9-21 d,平均为(15±4) d。治疗后早期无死亡病例。 2.2 随访结果 出院后随访共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。复查超声心动图彩色多普勒血流成像测量提示二尖瓣微量反流及微量以下反流67例,二尖瓣轻度反流9例。三尖瓣无明显反流35例,微量反流1例,轻度反流4例。 2.3 人工腱索移植前后超声心动图测量指标比较 见表2。门诊复查超声心动图显示治疗后各时间点与治疗前的指标比较,左心房内径明显减少(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),二尖瓣反流束面积/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)。所有病例均未出现二尖瓣前叶收缩期前向运动现象(SAM征)。 2.4 并发症及不良反应 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。其中3例阵发性室上性心动过速患者行同步电复律后好转。1例患者治疗前有心房颤动伴快-慢综合征,术后表现为间断的短暂意识丧失,心率变化较大,最快190次/min,最慢30次/min,动态心电图示R-R间期最长7 s,安装永久起搏器后好转。1例治疗后1周出现延迟性心包填塞的表现,经心包穿刺留置置管引流后治愈。 不良反应情况:所有患者中均无成形环断裂、成形环撕脱、溶血、左室流出道梗死、人工腱索断裂或劈裂等不良事件发生。无因二尖瓣反流程度加重或避免撕裂需要再次手术行瓣膜置换术的患者。"
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