Evaluation of the short-term effect of modified artificial tendon technique in mitral valvuloplasty
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摘要: 目的:探讨改良人工腱索(Loop)技术应用于二尖瓣成形术的近期效果。方法:选择2019年2月—2020年10月在本院治疗的二尖瓣关闭不全患者31例,所有患者均使用Loop技术行二尖瓣成形术,观察患者术中情况与术后心功能等。结果:31例患者使用Loop技术二尖瓣成形术均成功,手术中未发生二尖瓣置换或再次二尖瓣成形,平均植入Loop数为(2.2±0.6)个;手术中体外循环时间为(87.4±8.8) min,术中主动脉阻断时间为(60.7±7.9) min。围手术期无死亡病例;术后早期新发心房颤动2例,低心排综合征1例,急性肾功能不全1例。随访1~18个月,平均(10.7±2.3)个月,无死亡病例。与手术前相比,所有患者术后1周、1个月及半年的心功能、左室舒张末期内径(LVEDD)、二尖瓣口面积(MVA)、二尖瓣跨瓣压差(MVG)、每分输出量(CO)改善显著,差异有统计学意义(P<0.05)。手术中TEE结果显示,二尖瓣无反流或微量反流30例,轻度反流1例;术后1周无反流或微量反流30例,轻度反流1例;术后1个月无反流或微量反流29例,轻度反流2例;术后半年无反流或微量反流28例,轻度反流3例。结论:Loop技术应用于二尖瓣成形术对二尖瓣关闭不全的治疗效果较好,操作简单易行,重复性好,便于学习掌握,容易推广,并且随访观察近期治疗效果较好。Abstract: Objective: To explore the short-term effect of modified artificial tendon(Loop) technique in mitral valvuloplasty.Methods: Thirty-one patients with mitral regurgitation who were treated in our hospital from February 2019 to October 2020 were selected. All patients underwent Loop technique mitral valvuloplasty. The intraoperative condition and postoperative cardiac function were observed.Results: All patients treated with Loop technique mitral valvuloplasty were successful without mitral valve replacement or mitral valve reconstruction. The mean number Loop was(2.2±0.6), the mean time of cardiopulmonary bypass was(87.4±8.8) min, and the mean time of aortic clamp was(60.7±7.9) min. There was no death in the perioperative period. The early postoperative complications included new-onset atrial fibrillation in two cases, low cardiac output syndrome in one case, and acute renal insufficiency in one case. All patients were followed up for 1-18 months, with an average of(10.7±2.3) months, and there was no death. Compared with the preoperation, the cardiac function, left ventricular end-diastolic diameter(LVEDD), mitral orifice area(MVA), mitral valve gradient(MVG), and output per minute(CO) of all patients improved significantly after one week, one month and half a year(all P<0.05). TEE in the operation showed that there were 30 cases with no or slight mitral regurgitation and one case with mild mitral regurgitation; One week after the operation, 30 cases had no or slight regurgitation and one case had mild regurgitation; Half a year after the operation, 28 cases had no or slight regurgitation and three cases had mild regurgitation.Conclusion: The application of Loop technique in mitral valvuloplasty for the treatment of mitral regurgitation has a good effect, simple operation, good repeatability, is easy to learn and promote, and has good short-term treatment effect.
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Key words:
- mitral regurgitation /
- Loop /
- mitral valvuloplasty
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[1] Mahfouz RA,Elawady W,Goda M,et al.Redo scoring for prediction of success of redo-percutaneous balloon mitral valvuloplasty in patients with mitral restenosis[J].J Heart Valve Dis,2017,26(5):537-546.
[2] 栾果.二尖瓣成形术治疗儿童二尖瓣关闭不全的研究进展[J].重庆医学,2019,48(12):2099-2101,2106.
[3] Lange R,Guenther T,Noebauer C,et al.Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leaflet prolapse[J].Ann Thorac Surg,2010,89(4):1163-1170.
[4] 姜兆磊,梅举,丁芳宝,等.改良人工腱索联合瓣环成形术在二尖瓣脱垂修复中的应用及远期随访结果[J].中国胸心血管外科临床杂志,2016,23(5):430-433.
[5] 莫绪明,马际,朱煜,等.儿童二尖瓣脱垂外科诊治进展[J].中华实用儿科临床杂志,2018,33(23):1761-1765.
[6] 王睿,徐明,朱一帆,等.二尖瓣成形术在感染性心内膜炎二尖瓣关闭不全中的应用研究[J].中华医院感染学杂志,2019,29(7):1060-1063.
[7] David TE.Replacement of chordae tendineae with expanded polytetrafluoroethylene sutures[J].J Card Surg,1989,4(4):286-290.
[8] von Oppell UO,Mohr FW.Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops[J].Ann Thorac Surg,2000,70(6):2166-2168.
[9] Soga 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[J].Artif Organs,2002,26(9):802-805.
[10] 姜兆磊,梅举,汤敏,等.改良人工腱索技术在右胸微创切口二尖瓣成形术中的应用及效果评价[J].中国心血管病研究,2017,15(5):406-408.
[11] 王炜,王玮璠,王石雄,等.全胸腔镜下二尖瓣手术97例经验总结[J].临床心血管病杂志,2019,35(4):306-309.
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