| Objective:To summarize the selection of surgical methods,clinical indications and therapeutic effects of mitral valvuloplasty in patients with mitral incompetence heart disease.Methods:Retrospective analysis was performed on 153 patients undergoing mitral valuloplasty in our hospital from October 2016 to September 2017,including 81 males and 72 females,with an average age of(26.41 ± 24.61)years(0.2 ～ 74)years.Preoperative cardiac function grading(NYHA grading): 24 cases of Ⅰ grade,43 cases of normal grade,75 cases of normal grade,11 cases of acute grade.Preoperative echocardiography was performed for all patients:(< 14 years old)left atrial diameter(LAD)25.86 ± 7.57(13 ～ 50)mm,left ventricular end-diastolic diameter(LVEDD)31.80±7.73(18 ～ 49)mm,left ventricular end-systolic diameter(LVESD)19.09±5.53(8 ～ 34)mm,Left ventricular ejection fraction(LVEF)71.07%± 7.05%(56% ～ 89%),left atrial diameter(LAD)44.85 ± 9.99(29 ～ 69)mm,left ventricular end-diastolic diameter(LVEDD)53.89 ± 11.85(32 ～ 93)mm,LV final systolic diameter(LVESD)was 35.26±10.30(16 ～ 80)mm,and LVEF was 62.27%± 8.68%(35% ～ 78%).Preoperative degree of mitral regurgitation: 13 patients had mild to moderate regurgitation,86 patients had moderate to severe regurgitation,54 patients had severe regurgitation,and the area of mitral regurgitation was 7.29±6.41(0.5-33.4)cm2.Causes: 97(63.40%)cases of congenital heart disease,30(19.61%)cases of degenerative valvular heart disease,8(5.23%)cases of rheumatic heart disease,4(2.61%)cases of ischemic heart disease,9(5.88%)cases of primary infective endocarditis,5(3.27%)cases of left atrial myxoma.Before surgery,preoperative discussion combined with preoperative echocardiography and other examinations were used to evaluate the surgical status of the patients.Surgery under general anesthesia,moderately low or ultra-low temperature under extracorporeal circulation,the first bicuspid valves and valve valvuloplasty structure change is complete,disc ring keratoplasty: after using fracture repair,valve disc/partial nephrectomy,edge to edge technique of suture,chordae tendineae fold or transfer molding,artificial chordae tendineae forming,the boundary forming method,double hole forming,such as artificial disc ring forming operation method.The valve reflux and valve opening and closing were observed by water injection test during operation,and the valve opening and closing were observed by water injection again after the correction.The valve opening and closing condition and valve function were evaluated by transesophageal echocardiography after cardiac repulse,and it was suggested that the reflux was less than mild without mitral stenosis,which was considered as a successful surgery.Results:All 153 patients successfully completed the operation,and there were no deaths during the operation.Early postoperative mitral valve replacement was performed in 1case due to forming failure,and 1 case died early postoperative,with a mortality rate of 0.65%.The causes of death were: severe hypocardiac output syndrome and multiple organ dysfunction syndrome.The remaining 151 patients were discharged successfully after surgery.Echocardiography before postoperative discharge:(< 14 years old)left atrial diameter(LAD)20.82 ± 4.89(12 ～ 35)mm,left ventricular end-diastolic diameter(LVEDD)26.33 ± 5.66(14 ～ 40)mm,left ventricular end-systolic diameter(LVESD)17.26 ± 4.87(9 ～ 31)mm,Left ventricular ejection fraction(LVEF)66.06% ± 10.72%(33%-90%),left atrial diameter(LAD)36.44 ±7.21(25-59)mm,left ventricular end-diastolic diameter(LVEDD)46.26 ± 7.31(32-66)mm,(≥14 years old)LV final systolic diameter(LVESD)32.05±8.64(19-59)mm,LV ejection fraction(LVEF)57.20%± 9.86%(29%-75%).The degree of mitral regurgitation: there were 104 cases with no or minor regurgitation,35 cases with mild regurgitation,9 cases with moderate regurgitation,and 3 cases with severe regurgitation.The cardiac function of the patients was significantly improved compared with that before surgery,and the differences in various indexes were statistically significant(P < 0.05).151 patients were followed up by regular outpatient reexamination and telephone and text messages after discharge.The follow-up rate of138 patients was 91.4%,and the mean follow-up time was(19.2±16.7)months,from1 month to 49 months.Postoperative follow-up showed that 3(2.17%)patients were reoperated.Other patients had no serious complications such as reoperation,mitral stenosis,thrombus,liver and kidney failure,or death,and no new atrial fibrillation was found in ECG.Cardiac function was significantly improved compared with that before surgery,and the reflux and various indicators of the heart were significantly improved compared with that before surgery.Conclusion:Mitral valvuloplasty can be used as the first choice in the treatment of mitral valve insufficiency.According to different types and populations of mitral valve diseases,different shaping methods and comprehensive application of a variety of methods were adopted,and the simultaneous correction effect was good when combined with other heart diseases. |
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