Kumar Arkalgud Sampath, Talwar Sachin, Saxena Anita, Singh Rajvir, Velayoudam Devagourou
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India.
Interact Cardiovasc Thorac Surg. 2006 Aug;5(4):356-61. doi: 10.1510/icvts.2005.121590. Epub 2006 Apr 3.
Between January 1988 and December 2003, 898 patients with rheumatic heart disease (mean age 22.4+/-10.1 years) underwent mitral valve (MV) repair. Five hundred and sixty-five patients (63%) had pre-operative atrial fibrillation. Six hundred and ten (68%) patients were in NYHA class III or IV. Four hundred and twelve (45.9%) had pure mitral regurgitation (MR) and 486 (54.1%) had mixed mitral stenosis and MR. The pathology was leaflet prolapse (n=270, 30%), annular dilatation (n=717, 79.8%) and calcification (n=39, 4.3%). Reparative procedures included annuloplasty (n=793, 88%), commissurotomy (n=530, 59%), chordal shortening (n=225, 25%), cusp excision/plication (n=41, 4.5%), cuspal thinning (n=325, 36%), cleft suture (n=142, 16%), decalcification (n=30, 3.3%), chordal transfer (n=13, 1.4%), and neo chordae construction (n=3, 0.3%). Early mortality was 32 (3.6%). Follow-up ranged from 6 to 180 months (mean 62.7+/-31.8 months) and was 96% complete. Six hundred and twenty-one patients (69%) had no, or trivial, or mild MV. Two hundred and seventy-seven of the 866 survivors had MR which was moderate in 153 (18%) and severe in 124 (14%) patients. Thirty-five patients underwent re-operation. There were 21 late deaths (2.4%). Actuarial and re-operation-free survival at 10 years were 92+/-1.1% and 81+/-5.2%, respectively. Freedom from moderate or severe MR was 32+/-3.9%. MV repair in the rheumatic population is feasible with acceptable long-term results.
1988年1月至2003年12月期间，898例风湿性心脏病患者（平均年龄22.4±10.1岁）接受了二尖瓣修复术。565例患者（63%）术前存在心房颤动。610例（68%）患者为纽约心脏协会（NYHA）心功能Ⅲ级或Ⅳ级。412例（45.9%）为单纯二尖瓣反流（MR），486例（54.1%）为二尖瓣狭窄合并MR。病理表现为瓣叶脱垂（n = 270，30%）、瓣环扩张（n = 717，79.8%）和钙化（n = 39，4.3%）。修复手术包括瓣环成形术（n = 793，88%）、交界切开术（n = 530，59%）、腱索缩短术（n = 225，25%）、瓣尖切除/折叠术（n = 41，4.5%）、瓣尖变薄术（n = 325，36%）、裂口缝合术（n = 142，16%）、脱钙术（n = 30，3.3%）、腱索转移术（n = 13，1.4%）和人工腱索构建术（n = 3，0.3%）。早期死亡率为32例（3.6%）。随访时间为6至180个月（平均62.7±31.8个月），随访完整率为96%。621例患者（69%）无、轻度或仅有轻微二尖瓣病变。866例幸存者中有277例存在MR，其中153例（18%）为中度，124例（14%）为重度。35例患者接受了再次手术。有21例晚期死亡（2.4%）。10年的精算生存率和无需再次手术的生存率分别为92±1.1%和81±5.2%。免于中度或重度MR的比例为32±3.9%。在风湿性心脏病患者中进行二尖瓣修复术是可行的，长期效果可接受。
