Jonkaitiene Regina, Benetis Rimantas, Ablonskyte-Dūdoniene Rūta, Jurkevicius Renaldas
Clinic of Cardiology, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania.
Medicina (Kaunas). 2005;41(4):325-34.
This article analyzes data obtained from the medical records of the patients with primary mitral valve prolapse. The study population was the patients admitted to Kaunas University of Medicine Heart Center (KUMHC) between 1999 and 2003. The objective of our study was to analyze the natural course of mitral valve prolapse, complications and their frequency, treatment strategy in KUMHC, as well as to review the results of surgical treatment. We gathered data from the medical records of 160 patients and analyzed their age, medical history, complications, comorbidities, functional status and echocardiographic parameters. Patients who underwent mitral valve surgery were followed 7.9+/-8.4 months after procedure. On average, 32+/-14 patients with primary mitral valve prolapse were treated at KUMHC annually. Their mean age was 48.4+/-16.5 years, 44.4% of them were male. The most frequent complications of mitral valve prolapse were > or =II degrees mitral regurgitation (78.4%), various cardiac arrhythmias (68.1%) and heart failure of > or =II NYHA class (79%). Surgical treatment was recommended for 64 (40%) KUMHC patients with primary mitral valve prolapse. Surgical treatment was applied in 44 (28.1%) of study patients. The patients, who were recommended surgical treatment, were older (mean age 53.2+/-11.9 years, p<0.05) and predominantly male (62.5%, p<0.05) as compared to medically managed patients. The heart failure (62.5% had NYHA class III or IV), severe mitral regurgitation (95.3% had mitral regurgitation of > or =III degrees ) and worse left ventricle function (15% had ejection fraction of <50%) were more frequent in this group as compared to medically managed patients (all p<0.05). During the last five years the number of hospitalized patients with primary mitral valve prolapse increased 3.2 times, the number of mitral valve surgical procedures among these patients increased 2.8 times, and the number of mitral valve repair increased 15.8 times. 56.8% of patients had uncomplicated postoperative course. The most frequent postoperative complication was new arrhythmias and/or conduction disturbances. 1 patient died in early postoperative period. There was significant decrease in left ventricle and left atrium size and the severity of mitral regurgitation 2 to 6 months after mitral valve surgery. These positive changes remained during all study period. Taking in the consideration the large number of mitral valve repair procedures and good outcomes, the low postoperative mortality of the surgical mitral valve prolapse treatment in KUMHC, we can strongly recommend surgical treatment for the patients with severe mitral regurgitation secondary to mitral valve prolapse.
本文分析了从原发性二尖瓣脱垂患者的病历中获取的数据。研究人群为1999年至2003年期间入住考纳斯医科大学心脏中心（KUMHC）的患者。我们研究的目的是分析二尖瓣脱垂的自然病程、并发症及其发生率、KUMHC的治疗策略，以及回顾手术治疗的结果。我们从160例患者的病历中收集数据，并分析了他们的年龄、病史、并发症、合并症、功能状态和超声心动图参数。接受二尖瓣手术的患者在术后接受了7.9±8.4个月的随访。KUMHC每年平均治疗32±14例原发性二尖瓣脱垂患者。他们的平均年龄为48.4±16.5岁，其中44.4%为男性。二尖瓣脱垂最常见的并发症是≥II度二尖瓣反流（78.4%）、各种心律失常（68.1%）和≥II NYHA分级的心衰（79%）。64例（40%）KUMHC原发性二尖瓣脱垂患者被建议进行手术治疗。44例（28.1%）研究患者接受了手术治疗。与接受药物治疗的患者相比，被建议进行手术治疗的患者年龄更大（平均年龄53.2±11.9岁，p<0.05），且以男性为主（62.5%，p<0.05）。与接受药物治疗的患者相比，该组患者的心衰（62.5%为NYHA III或IV级）、严重二尖瓣反流（95.3%为≥III度二尖瓣反流）和较差的左心室功能（15%射血分数<50%）更为常见（所有p<0.05）。在过去五年中，原发性二尖瓣脱垂住院患者数量增加了3.2倍，这些患者中的二尖瓣手术数量增加了2.8倍，二尖瓣修复数量增加了15.8倍。56.8%的患者术后病程无并发症。最常见的术后并发症是新的心律失常和/或传导障碍。1例患者在术后早期死亡。二尖瓣手术后2至6个月，左心室和左心房大小以及二尖瓣反流严重程度显著降低。这些积极变化在整个研究期间持续存在。考虑到大量的二尖瓣修复手术和良好的结果，KUMHC手术治疗二尖瓣脱垂的术后低死亡率，我们强烈建议对二尖瓣脱垂继发严重二尖瓣反流的患者进行手术治疗。
