乳头肌瓣环固定技术在二尖瓣置换术中的应用
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摘要
目的分析乳头肌瓣环再固定(papillary muscle repositioning,PMR)技术在二尖瓣置换术中应用的可行性。方法回顾性分析2016年3月至2017年3月,以二尖瓣病变为主并实施PMR技术的瓣膜置换术(均置换的机械瓣膜)19例患者的临床资料,其中男10例、女9例,年龄(52.46±11.22)岁。分析其心功能改善情况及左心室形态等手术效果。结果患者围手术期死亡0例;开胸止血1例,低心排血量综合征(低心排)1例,强心利尿后好转,并顺利出院。术后仅1例出现大量血管活性药物的应用。心脏超声随访结果显示术后6个月左心室射血分数(LVEF)均较术前改善,出院前较术前降低;左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)较术前减小,差异具有统计学意义(P<0.05)。结论实施PMR技术的二尖瓣置换术在维持左心室乳头肌-二尖瓣环的张力和完整性,改善左室容积、左室形态和射血分数方面效果良好。
引文
1徐成阳,冯德广,王佳祥,等. 72例老年患者保留后瓣及瓣下结构的二尖瓣置换术治疗体会.中国现代药物应用, 2014, 8(11):76-77.
2符洪犊,白树堂,梁丽明,等.保留瓣叶及瓣下结构二尖瓣置换术480例临床分析.海南医学, 2015, 26(12):1810-1812.
3Yousefnia MA, Mandegar MH, Roshanali F, et al. Papillary muscle repositioning in mitral valve replacement in patients wth left ventricular dysfunction. Ann Thorac Surg, 2007, 83(3):958-963.
4Chowdhury UK, Kumar AS, Airan B, et al. Mitral valve replacement with and without chordal preservation in a rheumatic population:serial echocardiographic assessment of left ventricular size and function. Ann Thorac Surg, 2005, 79(6):1926-1933.
5Bozbu?a NU, Sahino?lu K, Ari Z, et al. Importance of the mitral subvalvular apparatus for left ventricular functional anatomy.Okajimas Folia Anat Jpn, 1999, 75(6):323-328.
6Soga Y, Nishimura K, Ikeda T, et al. Chordal-sparing mitral valve replacement using artificial chordae tendineae for rheumatic mitral stenosis:experience of the oblique method. Artif Organs, 2002,26(9):802-805.
7肖巍,张健群,肖明第,等.保留后瓣及瓣下结构的二尖瓣置换术临床分析.中国胸心血管外科临床杂志, 2012, 19(3):240-243.
8李继勇,张健群,伯平,等.改良保留前叶技术在二尖瓣置换术中的应用.中国胸心血管外科临床杂志, 2014, 21(2):189-193.
9Yun KL, Sintek CF, Miller DC, et al. Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement:Effects on left ventricular volume and function. J Thorac Cardiovascr Surg, 2002, 123(4):707-714.
10李继勇,张健群,伯平,等.不同保留瓣下结构方法行二尖瓣置换术的对比研究.心肺血管病杂志, 2014, 33(4):529-534.
11Lafci G, Cagli K, Cicek OF, et al. Papillary muscle repositioning as a subvalvular apparatus preservation technique in mitral stenosis patients with normal left ventricular systolic function. Tex Heart Inst J, 2014, 41(1):33-39.
12Yousefnia MA, Dehestani A, Saidi B, et al. Papillary muscle repositioning in valve replacement for left ventricular dysfunction:ischemic mitral regurgitation. Ann Thorac Surg, 2010, 90(2):497-502.
2符洪犊,白树堂,梁丽明,等.保留瓣叶及瓣下结构二尖瓣置换术480例临床分析.海南医学, 2015, 26(12):1810-1812.
3Yousefnia MA, Mandegar MH, Roshanali F, et al. Papillary muscle repositioning in mitral valve replacement in patients wth left ventricular dysfunction. Ann Thorac Surg, 2007, 83(3):958-963.
4Chowdhury UK, Kumar AS, Airan B, et al. Mitral valve replacement with and without chordal preservation in a rheumatic population:serial echocardiographic assessment of left ventricular size and function. Ann Thorac Surg, 2005, 79(6):1926-1933.
5Bozbu?a NU, Sahino?lu K, Ari Z, et al. Importance of the mitral subvalvular apparatus for left ventricular functional anatomy.Okajimas Folia Anat Jpn, 1999, 75(6):323-328.
6Soga Y, Nishimura K, Ikeda T, et al. Chordal-sparing mitral valve replacement using artificial chordae tendineae for rheumatic mitral stenosis:experience of the oblique method. Artif Organs, 2002,26(9):802-805.
7肖巍,张健群,肖明第,等.保留后瓣及瓣下结构的二尖瓣置换术临床分析.中国胸心血管外科临床杂志, 2012, 19(3):240-243.
8李继勇,张健群,伯平,等.改良保留前叶技术在二尖瓣置换术中的应用.中国胸心血管外科临床杂志, 2014, 21(2):189-193.
9Yun KL, Sintek CF, Miller DC, et al. Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement:Effects on left ventricular volume and function. J Thorac Cardiovascr Surg, 2002, 123(4):707-714.
10李继勇,张健群,伯平,等.不同保留瓣下结构方法行二尖瓣置换术的对比研究.心肺血管病杂志, 2014, 33(4):529-534.
11Lafci G, Cagli K, Cicek OF, et al. Papillary muscle repositioning as a subvalvular apparatus preservation technique in mitral stenosis patients with normal left ventricular systolic function. Tex Heart Inst J, 2014, 41(1):33-39.
12Yousefnia MA, Dehestani A, Saidi B, et al. Papillary muscle repositioning in valve replacement for left ventricular dysfunction:ischemic mitral regurgitation. Ann Thorac Surg, 2010, 90(2):497-502.