摘要目的 分析二尖瓣置换术后人工瓣膜患者不匹配(PPM)的发生原因.方法 连续入组2009年1月至6月间接受择期二尖瓣置换术的患者100例,男性37例,女性63例;年龄32～76岁,平均(52±9)岁.术前主要病变为二尖瓣狭窄60例,二尖瓣关闭不全14例,二尖瓣狭窄合并关闭不全26例;合并三尖瓣关闭不全63例.多普勒超声心动图测量人工二尖瓣膜有效瓣口面积,并计算有效瓣口面积指数(EOAI).以人工二尖瓣EOAI＜1.2 cm2/m2作为PPM诊断标准,将患者分为不匹配组和匹配组,对比分析两组患者临床资料.结果 52例患者二尖瓣置换术后发生PPM(52.0%).中度PPM 51例(51.0%),重度PPM 1例(1.0%).不匹配组中男性患者比例高于匹配组(55.8%比16.6%,P＜0.01),体表面积大于匹配组[(1.76±0.17)m2比(1.59±0.13)m2,P＜0.01].两组患者术前病理改变及术中应用人工瓣膜的种类、型号及手术方式无明显差异.术后两组患者心脏结构和功能及三尖瓣关闭不全的发生率无明显差异.结论 二尖瓣位PPM好发于男性、体表面积较大的患者.术中考虑性别、体表面积等因素,选择稍大型号的人工瓣膜,有利于减少术后PPM的发生.

abstractsObjective To analysis the causes of valve prosthesis-patient mismatch (PPM) after mitral valve replacement in Chinese patients. Methods Consecutive 100 patients for elective mitral valve replacement from January 2009 to June 2009 were enrolled and followed for this study. There were 37 males and 63 females. The mean age at operation was (52 ± 9 ) years ( ranging 32 to 76 years). The predominant mitral valve lesion was stenosis in 60 patients, regurgitation in 14 patients and mixed in 26 patients. Among them, 63 patients were combined tricuspid valve regurgitation.Mitral valve effective orifice area was measured by Doppler echocardiography in 100 patients who received mitral valve replacement and indexed for body surface area (EOAI). PPM was defined as not clinically significant if the EOAI was above 1.2 cm2/m2, as moderate ifit was ＞0.9 and ≤1.2 cm2/m2, and as severe ifit was ≤ 0.9 cm2/m2. By using the criteria, all 100 patients were classified to two groups: PPM group and no PPM group. The clinical characteristic of the patients between the two groups was compared to determine the causes of PPM and the predictors of outcomes after mitral valve replacement, such as the gender, age, valve prosthesis type, size,body surface area, and mitral valve lesion, et al. Results Of the 100 patients after MVR, 52 (52. 0% )had significant PPM, 51 (51.0%) had moderate PPM, and 1 (1.0%) had severe PPM. In comparison to patients in no PPM group, patients in PPM group had a significantly larger body surface area [( 1.76 ±0. 17) m2 vs. (1.59 ±0. 13) m2, P＜0.01] and higher prevalence of male gender (55.8% vs. 16.6%,P＜0. 01). The other preoperative and operative data were similar in both groups, such as the valve prosthesis type, size, and mitral valve lesion, et al. There were no significant differences in postoperative Doppler-echocardiographic data of cardiac structure and heart function between the two groups (P ＞ 0. 05 ).Conclusions The higher incidence of PPM in mitral valve position was in male or large body surface area patients. At the time of operation, surgeons should consider the related factors, such as the patient's gender and body surface area, et al. A larger prosthesis size might be implanted to avoid PPM in mitral valve position.