二尖瓣位生物瓣置换术后瓣膜毁损的临床特征及超声表现

目的探究二尖瓣位生物瓣膜置换术再次手术患者临床表现及超声心动图特征,为二尖瓣生物瓣膜毁损病因学诊断提供依据。方法回顾性分析24例经手术证实二尖瓣生物瓣膜置换术后,需再次手术患者的一般临床资料和超声心动图改变,总结患者心脏生物瓣膜毁损一般临床特征及超声表现。结果 24例患者中,中位年龄为66岁,男8例,女16例。24例中初次二尖瓣生物瓣置换术后出现生物瓣毁损再次手术原因:12例单纯性瓣膜关闭不全,4例瓣膜狭窄并关闭不全,3例瓣膜关闭不全合并瓣周漏,2例单纯性瓣膜狭窄,1例瓣膜关闭不全伴感染性心内膜炎,1例瓣膜狭窄伴附壁血栓,1例瓣膜关闭不全伴赘生物形成。结论二尖瓣位生物瓣置换术后行再次换瓣术间隔时间长短不一,本研究大部分病例生物瓣置换术后第8~9年之间出现瓣膜毁损需再次手术,时间短者大部与感染有关,时间长者大多与瓣膜老化有关。

Clinical Features and Echocardiographic Manifestations in Patients with Valve Damage After Mitral Valve Replacement

Objective To investigate the clinical manifestations and echocardiographic features of patients undergoing mitral bioprosthetic reoperation,and to provide clues for the etiology and pathogenesis of mitral valve destruction.Methods The clinical data and echocardiographic changes of 24 patients who underwent second mitral bioprosthetic replacement after primary mitral valve replacement surgery were retrospectively analyzed.The general clinical features and ultrasound findings of cardiac bioprosthetic lesions were summarized.Results Of the 24 patients,the median age was 66 years,8 males and 16 females.In 24 patients,bioprosthetic lesions occurred after primary mitral bioprosthetic valve replacement.Causes:12 patients with simple valvular insufficiency,4 with stenosis and regurgitation,3 cases of valvular insufficiency and perivalve leakage,2 cases of simple valvular stenosis,1 case of valvular insufficiency with infective endocarditis,1 case of valvular stenosis with wall thrombus,and 1 case of valvular insufficiency with neoplasm formation.Conclusions The length of interval between second and primary mitral bioprosthetic replacement surgery is different.In most cases,the valve is damaged between 8-9 years after bioprosthetic replacement,and the short-interval cases are related to infection,while long-interval cases are related to valve aging.