二尖瓣关闭不全的超声分型改进与术式选择的关系

目的分析二尖瓣关闭不全的超声分型改进与手术方式选择以及预后的关系，为二尖瓣关闭不全患者术前手术方式的选择提供新的形态学依据。方法４７例行二尖瓣重建术和４１例行二尖瓣置换术患者术前采用ＨＰＳｏｎｏｓ２５００多功能超声仪和２．５ＭＨｚ的探头行超声检查，根据二维显像上瓣叶的对位和对合情况分为三型。Ⅰ型：二尖瓣前后叶瓣尖处对位和对合均正常；Ⅱ型：二尖瓣对位正常，但对合异常；Ⅲ型：二尖瓣对位和对合均异常。结果４７例成形术患者的超声显像分型示，Ⅰ型占２０例，Ⅱ型３例，Ⅲ型２４例。术后接受超声随访的３４例患者中，１１例术后出现二尖瓣中、重度返流，包括Ⅰ型２例和Ⅲ型９例。Ⅲ型患者的预后远不如Ⅰ型和Ⅱ型（Ｐ＜０．０５）。４１例行二尖瓣置换术的患者中，Ⅲ型占３１例（７５．６％），其中合并腱索断裂或（和）严重瓣膜、瓣下结构受损者共占２５例。结论超声分型与二尖瓣关闭不全手术方式的选择有直接关系。

New criterion of echocardiographic classification of mitral valve insufficiency and its relationship to the surgical decision making

bjective To show the new criterion of echocardiographic classification of mitral valve insufficiency and its relationship to surgical decision making and postoperative effect. Therefore, to provided echocardiographically morphologic evidences for the preoperative decision making. HZMethods 88 patients with mitral insufficiency were studied by twodimensional echocardiographic imaging. HP Sonos 2500 echocardiographic system and 2.5 MHz probe were used for data acquisition. Among them 47 patients had undergone mitral valve reconstruction and 41 patients had undergone mitral valve replacement. Three patterns of leaflet closure were found. Type : normal apposition and coaptation; Type : normal apposition but deficient coaptation; Type : abnormal apposition and deficient coaptation. ResultsBZAmong the patients with mitral valve reconstruction, there were 20 cases of type, 3 cases of type and 24 cases of type . 34 cases were followed up postoperatively. Moderate or severe mitral regurgitation were found in 11 patients including 2 cases of type , 9 cases of type . The patients of type had a poorer prognosis than those of type and type ( P <0.05). On the other hand, among the patients with mitral valve replacement, 31 cases belonged to type (75.6%) and 25 cases were found to have ruptured chordae and serious lesions of the valve and subvalvular structure. Conclusions Echocardiographic classification of mitral valve insufficiency has a direct relationship to surgical patterns.