经主动脉切口治疗主动脉根部瘤合并二尖瓣病变

摘要

Objective To explore the experiences of treatment of aortic root aneurysm and mitral valve disease through the incision of aorta.Methods From Mar.2009 to Dec.2010, sixteen patients with aortic root aneurysm and mitral valve disease were operated by transaortic incision.After the leaflets of aortic valve were excised, mitral valve replacement or plasty was performed.There were 13 males and 3 females.The age ranged from 18 to 75 years old with a mean of (40 ± 10) years.The operation procedures included Bentall plus mitral valve replacement in 12 patients, Bentall plus mitral valve plasty in 1,Bentall + total arch replacement + stent elephant trunk + mitral valve plasty in 1, Bentall plus mitral valve plasty and CABG in 1.In 12 patients underwent mitral valve replacement, 11 were using continuous suture and interrupt mattress suture in 1.Four patients underwent mitral valve plasty, the procedure of banding mitral valve leaflets junctions was used.All patients were followed up through telephone and out-patient service.Transthoracic echocardiogram was performed before discharge and 3-, 6-,12-months after operation.Follow-up including cardiac function, valvular and perioperative complications.Results There were 2 re-thoractomy because of bleeding.One patient with pulmonary infection was cured by antibiotics.No death occurred in hospital.Patients were followed-up for 1 to 19 months with a mean of (7 ±5) months.No death occurred during follow-up period.There were no valve-related complications (embolism, bleeding, mitral valve dysfunction).Heart function was improved in all patients and graded as class Ⅰ to Ⅱ (NYHA).Two patients had trace regurgitation after mitral valve plasty when discharged.One patient had mild mitral valve regurgitation was found after mitral valve replacement.There was no further valve exacerbation for above 3 patients during follow-up period.Conclusion Transanrtic mitral valve operation is feasible in patients with aortic root aneurysm and mitral valve disease.%目的 总结经主动脉切口治疗主动脉根部瘤合并二尖瓣病变的初步经验。方法 2009年3月至2010年12月，经主动脉瓣口行二尖瓣手术16例中男13例，女3例；年龄18～ 75岁，平均(40±10)岁。16例中Bentall+ MVR术12例，Bentall+ MVP术1例，Bentall+全弓置换+支架象鼻+MVP术1例，Bentall+ MVP+ CABG术2例。12例行二尖瓣置换术，其中11例用连续缝合法置换二尖瓣，l例采用间断褥式缝合方法置换二尖瓣。4例行二尖瓣成形术，均为二尖瓣前后交界的Key环缩。术后通过门诊就诊和电话询问进行随访。随访内容包括心功能、瓣膜情况和术后并发症。出院前行经胸心脏超声检查，出院后3、6、12个月各行1次超声检查，以后每年1次。结果 2例再次开胸止血。1例因术后肺部感染给予抗感染治疗后治愈。无围术期及随访期死亡。随方1 ～19个月，平均(7±5)个月。无瓣膜相关并发症。随访期全部患者心功能(NYHA分级)为Ⅰ～Ⅱ级。4例行成形术者中2例二尖瓣房侧微量反流，术后平均随访5个月，随访过程中无进一步发展，患者亦无不适症状。12例二尖瓣置换术者中，1例出院前经胸心脏超声发现二尖瓣短轴9点位收缩期左房侧瓣环外少量反流信号，术后随访过程中无进一步加重。结论 对主动脉根部病变主动脉瓣环扩大合并二尖瓣病变者，经主动脉瓣口行二尖瓣手术，是一种可行的手术路径。