• 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院心臟外科， 北京 100029;

目的 　嘗試在非體外循環(huán)冠狀動脈旁路移植術(shù)（OPCAB）期間對輕至中度缺血性二尖瓣反流（IMR）患者采用自制二尖瓣成形裝置進行外科處理，并評估其療效。方法 　回顧性分析自 2009年 9月至 2011年 8月北京安貞醫(yī)院 6例輕至中度 IMR患者（男 4例、女 2例，年齡 52～73歲）在 OPCAB期間采用自制二尖瓣成形裝置進行二尖瓣成形的臨床資料。在處理 IMR前及處理后通過經(jīng)食管超聲心動圖測定 IMR程度、二尖瓣瓣環(huán)前后徑、左心室短軸徑、左心室長軸徑、左心室球形指數(shù)（左心室短軸徑 /左心室長軸徑）等；通過 Swan-Ganz導(dǎo)管測量并記錄主動脈平均壓、肺動脈平均壓和中心靜脈壓等。比較圍術(shù)期相關(guān)心功能指標(biāo)。結(jié)果 　無住院死亡。二尖瓣成形后 IMR均消失、二尖瓣瓣環(huán)前后徑［（3.43±0.08）cm vs.（3.68±0.08）cm；t=5.430，P=0.001］、左心室短軸徑［（4.80±0.21） cm vs.（5.53±0.11）cm；t=7.530, P=0.001］和左心室球形指數(shù)（ 0.64±0.02 vs. 0.74±0.01；t=11.110，P=0.002）均較處理前明顯減小；左心室長軸徑無明顯變化（ P＞ 0.05）；術(shù)中血流動力學(xué)指標(biāo)無明顯變化。術(shù)后 3個月 6例患者（隨訪率 100%）均在門診復(fù)查，均無自主臨床癥狀，心功能均改善至Ⅰ級（ NYHA）。超聲心動圖提示：二尖瓣無反流 4例，有微量反流 2例。結(jié)論 　在 OPCAB期間采用自制二尖瓣成形裝置成形治療 IMR，直接完成了左心室塑型，規(guī)避了體外循環(huán)風(fēng)險，即刻療效確切，對循環(huán)指標(biāo)影響甚小，有一定的臨床應(yīng)用價值。

引用本文： 于洋,顧承雄,李京倖等. 非體外循環(huán)下采用自制二尖瓣成形裝置手術(shù)治療輕至中度缺血性二尖瓣關(guān)閉不全. 中國胸心血管外科臨床雜志, 2012, 19(3): 244-247. doi: 復(fù)制

1. 　Magne J, Sénéchal M, Dumesnil JG, et a1. Ischemic mitral regurgitation： a complex multifaceted disease. Cardiology, 2009, 112（4）：244-259.
2. 　Lamas GA, Mitchell GF, Flaker GC, et a1．Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators.Circulation, 1997, 96（3）：827-833．.
3. 　Fattouch K, Sampognaro R, Speziale G, et a1. Impact of moderate ischemic mitral regurgitation after isolated coronary artery bypass grafting.Ann Thorac Surg, 2010, 90（4）：1187-1194.
4. 　Aklog L, Filsoufi F, Flores KQ, et a1. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation, 2001, 104（12 Suppl 1）：I68-I75.
5. 　Bouma W, van der Horst IC, Wijdh-den Hamer IJ, et a1. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches. Eur J Cardiothorac Surg, 2010, 37（1）：170-185.
6. 　于洋, 顧承雄, 韋華, 等. OPCAB同時行左心室室壁瘤縫縮術(shù)206例.中華胸心血管外科雜志, 2007, 23（3）：154-155.
7. 　Burch GE, De Pasquale NP, Phillips JH. Clinical manifestations of papillary muscle dysfunction. Arch Intern Med, 1963, 112：112-117.
8. 　Mittal AK, Langston M Jr, Cohn KE, et a1. Combined papillary muscle and left ventricular wall dysfunction as a cause of mitral regurgitation. An experimental study. Circulation, 1971, 44（2）：174-180.
9. 　Agricola E, Oppizzi M, Pisani M, et al. Ischemic mitral regurgitation： mechanisms and echocardiographic classification. Eur J Echocardiogr, 2008, 9（2）：207-221.
10. 　紀(jì)廣玉, 徐志云, 鄒良建，等. 冠心病合并慢性中度缺血性二尖瓣關(guān)閉不全的外科治療.中國胸心血管外科臨床雜志, 2007, 14（4）：248-251.
11. 　吳若彬, 鄭少憶, 郭惠明, 等. 冠心病合并缺血性二尖瓣關(guān)閉不全的處理方法. 中華胸心血管外科雜志，2004, 20（5）：271-273.
12. 　Marasco SF. Ischaemic mitral regurgitation and the role of surgical intervention. Heart Lung Circ, 2008, 17（ Suppl 4）：S14-S20.
13. 　Grossi EA，Crooke GA，DiGiorgi PL，et a1．Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. Circulation, 2006, 114（Suppl 1）：1573-1576．.
14. 　Forouzannia SK, Abdollahi MH, Mirhosseini SJ, et a1. Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery. Acta Med Iran, 2011, 49（7）：414-419.
15. 　Liel-Cohen N, Guerrero JL, Otsuji Y, et a1. Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation： insights from 3-dimensional echocardiography.Circulation, 2000, 101（23）：2756-2763.
16. 　Bach DS, Deeb GM, Bolling SF. Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation.Am J Cardiol, 1995, 76（7）：508-512.
17. 　Lancellotti P, Troisfontaines P, Toussaint AC, et a1. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation, 2003, 108（14）：1713-1717.
18. 　Campwala SZ，Bansal RC，Wang N，et a1．Mitral regurgitation progression following isolated coronary artery bypass surgery： frequency, risk factors, and potential prevention strategies.Eur J Cardiothorac Surg, 2006, 29（3）：348-353．.
  1. 1. 　Magne J, Sénéchal M, Dumesnil JG, et a1. Ischemic mitral regurgitation： a complex multifaceted disease. Cardiology, 2009, 112（4）：244-259.
  2. 2. 　Lamas GA, Mitchell GF, Flaker GC, et a1．Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators.Circulation, 1997, 96（3）：827-833．.
  3. 3. 　Fattouch K, Sampognaro R, Speziale G, et a1. Impact of moderate ischemic mitral regurgitation after isolated coronary artery bypass grafting.Ann Thorac Surg, 2010, 90（4）：1187-1194.
  4. 4. 　Aklog L, Filsoufi F, Flores KQ, et a1. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation, 2001, 104（12 Suppl 1）：I68-I75.
  5. 5. 　Bouma W, van der Horst IC, Wijdh-den Hamer IJ, et a1. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches. Eur J Cardiothorac Surg, 2010, 37（1）：170-185.
  6. 6. 　于洋, 顧承雄, 韋華, 等. OPCAB同時行左心室室壁瘤縫縮術(shù)206例.中華胸心血管外科雜志, 2007, 23（3）：154-155.
  7. 7. 　Burch GE, De Pasquale NP, Phillips JH. Clinical manifestations of papillary muscle dysfunction. Arch Intern Med, 1963, 112：112-117.
  8. 8. 　Mittal AK, Langston M Jr, Cohn KE, et a1. Combined papillary muscle and left ventricular wall dysfunction as a cause of mitral regurgitation. An experimental study. Circulation, 1971, 44（2）：174-180.
  9. 9. 　Agricola E, Oppizzi M, Pisani M, et al. Ischemic mitral regurgitation： mechanisms and echocardiographic classification. Eur J Echocardiogr, 2008, 9（2）：207-221.
  10. 10. 　紀(jì)廣玉, 徐志云, 鄒良建，等. 冠心病合并慢性中度缺血性二尖瓣關(guān)閉不全的外科治療.中國胸心血管外科臨床雜志, 2007, 14（4）：248-251.
  11. 11. 　吳若彬, 鄭少憶, 郭惠明, 等. 冠心病合并缺血性二尖瓣關(guān)閉不全的處理方法. 中華胸心血管外科雜志，2004, 20（5）：271-273.
  12. 12. 　Marasco SF. Ischaemic mitral regurgitation and the role of surgical intervention. Heart Lung Circ, 2008, 17（ Suppl 4）：S14-S20.
  13. 13. 　Grossi EA，Crooke GA，DiGiorgi PL，et a1．Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. Circulation, 2006, 114（Suppl 1）：1573-1576．.
  14. 14. 　Forouzannia SK, Abdollahi MH, Mirhosseini SJ, et a1. Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery. Acta Med Iran, 2011, 49（7）：414-419.
  15. 15. 　Liel-Cohen N, Guerrero JL, Otsuji Y, et a1. Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation： insights from 3-dimensional echocardiography.Circulation, 2000, 101（23）：2756-2763.
  16. 16. 　Bach DS, Deeb GM, Bolling SF. Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation.Am J Cardiol, 1995, 76（7）：508-512.
  17. 17. 　Lancellotti P, Troisfontaines P, Toussaint AC, et a1. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation, 2003, 108（14）：1713-1717.
  18. 18. 　Campwala SZ，Bansal RC，Wang N，et a1．Mitral regurgitation progression following isolated coronary artery bypass surgery： frequency, risk factors, and potential prevention strategies.Eur J Cardiothorac Surg, 2006, 29（3）：348-353．.