· 临床研究·

    作者单位:200032 上海,复旦大学附属中山医院 上海市心血管病

    研究所超声心动图室

    超声心动图评价二尖瓣环成形术中应用

    三种不同人工瓣环后的中期疗效

    潘翠珍 舒先红 周密 施月芳 潘文明 程蕾蕾 葛均波 陈灏珠

    【摘要】 目的 超声心动图评价二尖瓣环成形术中应用三种不同人工瓣环的中期疗效 ,为临床上合

    理选用人工二尖瓣环提供参考。方法 心外科施行二尖瓣成形术中植入 Carpentier 硬环、 Duran 闭合环、Cosgrove开放软环的 69 例患者 ,Carpentier 环组(CA 组) 19 例 , Duran 环组(DU 组) 28 例 ,Cosgrove 环组

    (CO组) 22 例 ,均为二尖瓣关闭不全患者。记录所有患者术前、术后二维超声心动图资料 ,包括二尖瓣反流

    程度、二尖瓣跨瓣压差、跨瓣最大流速、二尖瓣环收缩末和舒张末横径、二尖瓣环收缩末和舒张末纵径、左

    室射血分数、左房内径、肺动脉收缩压、左室收缩末容积、左室舒张末容积、室壁增厚率(ΔT %) 。15 例患

    者术后随访实时三维超声心动图 ,包括二尖瓣环舒张末、收缩末面积和面积变化率。结果 共随访到 68

    例患者 ,随访率 98. 5 % ,平均随访时间为(9. 3 ±7. 4)个月。术后三组二尖瓣反流程度均较术前显著下降

    ( P < 0. 001) ,二尖瓣跨瓣压差及二尖瓣血流速度较术前升高( P < 0. 05 , P < 0. 001) ,二尖瓣环直径均较

    术前明显缩短( P < 0. 05) 。术后人工二尖瓣环收缩末与舒张末直径变化率比较 ,横径 CA 组小于其他两

    组 ,纵径 CA组小于 DU 组 ,DU 组小于 CO组(均 P < 0. 05) 。实时三维超声检测二尖瓣环面积变化率 ,CA

    组小于其他两组( P < 0. 05) ,DU 组与 CO组差异无显著性意义( P > 0. 05) 。术后左房内径、肺动脉收缩

    压、左室容积均较术前下降 ,ΔT %升高(均 P < 0. 05) 。结论 应用软环能更好地保留二尖瓣环的舒缩功

    能 ,而且 Cosgrove软环可能优于 Duran软环。Cosgrove软环改善心功能的作用可能优于 Carpentier 硬环和

    Duran软环。

    【关键词】 超声心动描记术;二尖瓣;心脏瓣膜 ,人工

    Evaluation of results of three different prosthetic rings in mit ral annuloplasty by echocardiography PA N

    Cui2z hen , S HU Xian2hong , ZHOU Mi , et al . Department of Echocardiography , Zhongshan Hospi tal of

    Fudan University , S hanghai Inst itute of Cardiovascular Diseases , S hanghai 200032 ,China

    【Abst ract】 Objective To evaluate the results of mit ral annuloplasty with Carpentier rigid ring , or Duran

    flexible ring , or Cosgrove annuloplasty band by echocardiography. Methods Totally 69 patients were enrolled

    and divided into three groups : Carpentier group (CA group , n = 19) , Duran group (DU group , n = 28) , and

    Cosgrove group (CO group , n = 22) . Echocardiography was taken to record the degrees of mit ral regurgitation

    (MR) ,t rans 2valvular gradient ( TVG) ,peak t rans 2mit ral flow velocity ( TMFV) ,t ransverse and vertical length of

    mit ral annulus , left vent ricle(LV) EF , diameter of left at rium(LAD) , pulmonary systolic pressure (PASP) , end2

    systolic and diastolic volume of LV ,change of thickness of the LV wall (ΔT %) . Real2time three dimensional

    echocardiography(RT23DE) was used to record mit ral orifice area(MVA) , and change rate of the MVA. Results

    The follow2up was completed in 68 patients(98. 5 %) and the mean follow2up time was (9. 3 ±7. 4) months.

    The degree of MR after operation was less than that before operation ( P < 0. 001) , and TVG and TMFV

    increased in all three groups ( P < 0. 05 , P < 0. 001) . The diameter of mit ral orifice post2 operatively decreased

    after annuloplasty than that pre2 operatively ( P < 0. 05) . The change of t ransverse length of CA group was less

    than other two groups ( P < 0. 05) . The change of vertical length of CA group was the slightest , and less than

    DU group , and than the CO group ( P < 0. 05) . Change of the MVA of CA group was less than the other two

    groups with RT23DE ( P < 0. 05) . LAD , PASP and end 2systolic and diastolic volume of LV were significant

    decreased andΔT % increased post2 operatively ( P < 0. 05) . Conclusions Flexible ring is bet ter to preserve

    mit ral annular function than rigid ring , and Cosgrove ring may be bet ter uhan Duran ring. Cosgrove ring is the

    best to improve heart function.

    【Key words】 Echocardiography ;Mit ral valve ;Heart valve prosthesis

    · 523 · 中华超声影像学杂志2004 年5 月第13 卷第5 期 Chin J Ult rasonogr ,May 2004 ,Vol 13 ,No. 5

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