两种人工瓣环置入修复单纯二尖瓣环扩张引起的二尖瓣关闭不全的比较

背景：退行性二尖瓣关闭不全的病例有逐渐增加的趋势，而单纯二尖瓣环扩张引起的二尖瓣关闭不全是退行性二尖瓣关闭不全的一种类型，国内尚无关于此类二尖瓣关闭不全的外科治疗的临床研究报告。 目的：观察单纯瓣环置入修复单纯二尖瓣环扩张引起的二尖瓣关闭不全早中期生物相容性的反应。 方法：单纯二尖瓣瓣环扩张致二尖瓣关闭不全患者48例，均行二尖瓣人工瓣环置入修复，其中使用Carpentier-Edwards生理环23例、SJMTM刚性鞍形成形环25例。出院后随访，采用超声心动图观察心功能和二尖瓣反流程度等变化，并比较两种瓣环与宿主生物相容性有无差别。 结果与结论：围术期无死亡，均治愈出院。48例均获随访，随访率100%，随访时间3个月至4年，无死亡病例。NYHA心功能分级Ⅰ级32例，Ⅱ级16例。与术前比较，随访期超声心动图显示左心房内径、左心室舒张末期内径、左心室收缩末期内径、肺动脉收缩压和反流速面积/左房面积均明显减少(P < 0.01)，左室射血分数明显增加(P < 0.01)。跨瓣压差均< 3 mm Hg。二尖瓣无明显返流36例，微量返流10例，轻度反流2例。未出现成形环断裂、成形环撕脱及溶血现象。Carpentier-Edwards生理环组和SJMTM刚性鞍形成形环组比较，上述各指标差异无显著性意义(P > 0.05)。结果提示对于因单纯二尖瓣环扩张引起的退行性二尖瓣关闭不全，通过正确的置入技巧、选择合适的人工瓣环，应用人工瓣环置入有与宿主生物较好的生物相容性反应，置入后的瓣膜替代功能良好。中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程全文链接：

Two kinds of artificial valve rings in the treatment of degenerative mitral regurgitation due to pure mitral valve ring expansion

BACKGROUND: Incidence of degenerative mitral regurgitation show a gradual increase tendency, but there is no report on degenerative mitral regurgitation due to pure mitral valve ring expansion in China. OBJECTIVE: To summarize the early and midterm outcomes of pure mitral valve annuloplasty in the treatment of degenerative mitral regurgitation due to pure mitral valve ring expansion. METHODS: Forty-eight patients with degenerative mitral regurgitation due to pure mitral valve ring expansion underwent pure mitral valve annuloplasty, including 23 cases treated with Carpentier-Edwards Physio ring and 23 with SJMTM rigid saddle ring. After discharge, echocardiography was used to evaluate heart function and mitral regurgitation degree during the follow-up. The outcomes were compared between the two groups. RESULTS AND CONCLUSION: There was no early death after operation and all cases were cured and discharged. All patients were followed up for 3 months to 4 years, and the cardiac function and mitral valve regurgitation were significantly improved (no mitral regurgitation in 36 cases, trivial mitral regurgitation in 10 cases and mild mitral regurgitation in 2 cases). According to NYHA grading, there were 32 cases of level I and 16 cases  of level II. The echocardiography showed that postoperative left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, pulmonary artery systolic pressure and the ratio of regurgitation beam area to left atrial area were significantly lower than those before operation (P < 0.01). The left ventricular ejection fraction increased greatly (P < 0.01). There was no ring rupture, ring avulsion and hemolysis. Postoperative transvalvular pressure was less than 3 mm Hg. However, there were no significant differences in the above-mentioned parameters between the Carpentier-Edwards Physio ring and SJMTM rigid saddle ring groups. The results suggest that the pure mitral valve annuloplasty is excellent in the treatment of degenerative mitral regurgitation due to pure mitral valve ring expansion, through the right surgical techniques and the right choice of artificial valve ring.