二尖瓣置换术中保留瓣下结构对心功能的影响

Effect of preservation of the subvalvular apparatus on cardiac function in mitral valve replacement

摘要:

目的： 探讨二尖瓣置换术术中保留二尖瓣瓣下结构对心功能恢复的影响及预后。方法： 分析2016年3月至2019年9月在重庆医科大学第一附属医院行二尖瓣置换术的92例患者。其中保留二尖瓣后瓣及瓣下结构有48例（试验组），其余44例患者行传统二尖瓣置换术（对照组）。分析试验组与对照组（包括组内与组间）术前、术后7 d、术后3个月、术后6个月的心脏彩色多普勒检查情况，分析试验组与对照组围手术期情况及术后心功能恢复情况。结果： 试验组术后血管活性药物运用时间[（4.25±1.19）d]明显短于对照组[（5.64±1.63）d]（P<0.05），试验组并发症发生率（8.34%）明显低于对照组（25.00%）（P=0.031）。术后6个月，试验组左心房内径（left atrial diameter，LAD）[（32.64±3.76）mm]、左室舒张末期内径（left ventricular end diastolic diameter，LVEDD）[（43.60±3.68）mm]、左室收缩末期内径（left ventricular end systolic diameter，LVESD）[（31.81±4.73）mm]均明显低于对照组，试验组左室射血分数（left ventricular ejection fraction，LVEF）（64.86±4.23）%、左室短轴缩短率（left ventricular fraction shortening，LVFS）[（36.04±2.90）%]均明显高于对照组（P<0.05）。结论： 二尖瓣置换术中保留二尖瓣瓣下结构有助于术后心功能的恢复和短期改善左心功能。

Abstract:

Objective: To investigate the effect and prognosis of preservation of the subvalvular apparatus on left ventricular functions in mitral valve replacement. Methods: Retrospective analysis was made among 92 patients who underwent mitral valve replacement in The First Affiliated Hospital of Chongqing Medical University from March 2016 to September 2019. Those patients were divided into two groups, among which, 48 cases preserved the posterior and subvalvular apparatus of mitral valve (experimental group), while the other 44 cases underwent traditional mitral valve replacement (control group). Parameters of left ventricular function of echocardiographic measurements were compared between experimental group and control group at preoperative, early postoperative period (7 days after surgery) and late postoperative period (3 months, 6 months after surgery), and perioperative conditions, etc. Results: The application time of vasoactive drugs in the experimental group was significantly shorter than that in the control group [(4.25±1.19) days vs. (5.64±1.63) days, P<0.05], and the incidence of complications in the experimental group (8.34%) was significantly lower than that in the control group (25.00%) (P=0.031). Six months after the operation, the left atrial diameter (LAD) [(32.64±3.76) mm], left ventricular end diastolic diameter (LVEDD) [(43.60±3.68) mm]and left ventricular end systolic diameter (LVESD) [(31.81±4.73) mm]were significantly lower in the experimental group than those in the control group. The left ventricular ejection fraction (LVEF) [(64.86±4.23) %]and left ventricular fraction shortening (LVFS) [(36.04±2.90) %]were significantly higher in the experimental group than in the control group (P<0.05). Conclusion: Mitral valve replacement with preservation of subvalvular apparatus is beneficial for renewing cardiac function and a short-term improvement of left ventricular function.