目的 通过观察大样本二尖瓣腱索断裂(MCTR )的超声心动图和手术特点,探讨MCTR 疾病分布特点、经胸超声心动图(TTE )特征,并明确其在指导手术中的价值.资料与方法收集5 年以来在北京阜外心血管病医院住院的295 例MCTR 患者病例资料,记录所有患者心电图、经胸超声心动图、手术结果,将结果进行比较分析.结果 295 例MCTR 患者中,前叶腱索断裂100 例,后叶腱索断裂182 例,前后叶腱索均断裂13 例;腱索完全断裂26 例,部分断裂269 例;进行换瓣手术110 例,修补手术132 例.本组MCTR 的主要超声特点为二尖瓣叶脱垂、出现连枷样或挥鞭样改变、二尖瓣中～重度反流、心脏扩大、轻中度肺动脉高压.根据手术结果判断,TTE 对MCTR 的诊断符合率为96.7% ;判断前后叶脱垂和腱索断裂的诊断符合率为92.5%,准确判断为完全和部分腱索断裂的诊断符合率为89.3%.TTE 的主要误诊原因是在判断腱索摆动与断裂腱索、二级腱索断裂部位仍有缺陷和缺少经验.经过统计学分析,MCTR 是进行换瓣还是修补手术,与附着瓣叶的部位有关(P ＜0.05),而腱索是否部分或完全断裂与手术方式的选择无关(P ＞0.05).结论 经胸超声心动图能够准确地诊断大部分MCTR,并且能够协助外科医生进行初步分型和选择手术方式.%Purpose To compare the echocardiographic characteristics of mitral chordae tendinae rupture (MCTR) with surgical results. Materials and Methods Electrocardiogram, echocardiography and surgery were pertormed in 295 consecutive in-patients with MCTR in Fuwai Hospital during 5 years. Results There were 100 patients with rupture of the anterior leaflet, 182 patients with rupture of the posterior leaflet, and the remainder 13 patients had rupture of both leaflets. Partial MCTR was found in 269 cases and total MCTR in 26 cases One hundred and ten patients underwent valve replacement and 132 had valve repair. Analysis of echocardiography demonstrated that most patients presented with mitral valve prolapse, flailing nfitral valve, moderate to severe mitral regurgitation, dilated heart chamber and mild to moderate pulmonary artery hypertension. The TTE diagnosis was consistent to surgical results in 96.7％ of the patients with 92.5％ for posterior or anterior MCTR and 89.3％ for total or partial MCTR. The main reason for misdiagnosis by TTE was difficulty in differentiating the swinging tendons from ruptured chordae tendineae; another reason was misdiagnosing the site of second level chordae tendineae. Surgical procedures for MCTR mainly depended on the location of MCTR(P ＜ 0.01), but not total or partial MCTR(P＞0.05). Conclusions Echocardiography can accurately diagnose MCTR and can be used to guide the choice of surgical procedures.
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