摘要目的 探讨缘对缘瓣叶缝合技术的特点及其治疗退行性二尖瓣关闭不全的疗效.方法 回顾性分析2000年1月至2009年1月58例因退行性二尖瓣关闭不全行缘对缘瓣叶缝合技术治疗的患者的临床资料.58例患者中男性32例,女性26例；年龄43～65岁,平均(56±6)岁.二尖瓣中度反流18例,重度反流40例.前瓣叶脱垂50例,双瓣叶脱垂8例.58例患者均采用缘对缘瓣叶缝合技术,其中44例患者同期行瓣环成形术.通过电话、信件、门诊复查等方式进行随访.结果 围手术期无死亡和严重并发症发生.58例患者术后复查经胸超声心动图提示左心室、左心房明显缩小(P均＜0.05),二尖瓣反流明显改善(无反流9例、微量反流30例、轻度反流19例),且无狭窄发生.58例患者术后随访24～95个月,平均(58±20)个月.随访期间死亡2例,死亡原因均为非心源性.二尖瓣重度反流1例、中度反流3例,无狭窄发生.术后5年二尖瓣再次中重度反流免除率为91.9％.随访中根据手术时是否行瓣环成形术,将58例患者分成缘对缘瓣叶缝合组14例和缘对缘瓣叶缝合+瓣环成形组44例,生存分析显示,缘对缘瓣叶缝合+瓣环成形组患者术后远期二尖瓣再次中重度反流免除率更高(x2=4.034,P=0.045).结论 缘对缘瓣叶缝合技术治疗退行性二尖瓣关闭不全围手术期及术后远期成形效果良好,与瓣环成形技术联合应用可提高术后远期成形效果.

abstractsObjectives To explore the feature of the edge-to-edge technique and its effect for mitral regurgitation due to myxomatous degeneration.Methods The in-patient data and follow-up outcomes of 58 patients after the edge-to-edge technique for mitral regurgitation due to myxomatous degeneration from January 2000 to January 2009 were analyzed retrospectively.Of the 58 patients,32 patients were male and 26 patients were female,and the age range was from 43 years to 65 years with a mean of (56 ± 6) years,and moderate mitral regurgitation was observed in 18 patients and severe regurgitation in 40 patients,and the prolapse of the anterior leaflet was observed in 50 patients and the prolapse of the bileaflet in 8 patients.The edge-to-edge technique was performed in all patients and the annuloplasty was performed in 44 patients.Results There was no perioperative death and serious complication.Postoperative transthoracic echocardiography of all the survivors indicated that the dimensions of left atrial and left ventricular were obviously decreased (P ＜ 0.05 ) and mitral insufficiency was obviously improved (no regurgitation was observed in 9 patients and trace regurgitation in 30 patients and mild regurgitation in 19 patients) and there was no mitral stenosis.Totally 58 patients were followed up from 24 months to 95 months with a mean of (58 ± 20) months.During the follow-up,there were 2 deaths for noncardiac factors.Freedom from recurrent moderate or severe mitral regurgitation at 5 years after operations was 91.9％.According to undergoing combined annuloplasty or not,58 patients were divided into the edge-to-edge technique group ( 14 cases)and the edge-to-edge technique + annuloplasty group (44 cases),and the survival analysis shows there was significant difference on freedom from long-term recurrent moderate or severe mitral regurgitation after operations between two groups ( x2 =4.034,P =0.045 ) and long-term effect of the latter group was better.Conclusions The edge-to-edge technique can be conveniently used and bring about satisfactory perioperative and long-term effects for mitral regurgitation due to myxomatous degeneration.The combination of the edge-to-edge technique and the annuloplasty can improve the long-term effect significantly.