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镜像右位心并风湿性联合心脏瓣膜病一例

Comparison between Minimally Invasive Mitral Valve Replacement via Right Minithoracotomy and Traditional　Mitral Valve Replacement

Objective To compare clinical outcomes and safety between minimally invasive mitral valve replacement via right minithoracotomy （mini-MVR） and traditional mitral valve replacement （MVR）. Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively， there were 21 patients with mitral stenosis （MS）， 17 patients with mitral insufficiency （MI）， 30 patients with MS and MI， and 19 patients with tricuspid insufficiency （TI）. Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4±13.2 years. Preoperatively， there were 85 patients with MS， 66 patients with MI， 49 patients with MS and MI， and 76 patients with TI. Hospital mortality， aortic crossclamp time， length of intensive care unit （ICU） stay， postoperative chest tube drainage， reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality， cardiopulmonary bypass time， incidence of reexploration for bleeding， postoperative arrhythmias， dialysis-requiring acute renal failure and wound infection between the two group （P＞0.05）. Aortic crossclamp time of the mini-MVR group was significantly longer than that of the control group. But postoperative mechanical ventilation time （10.2±3.1 h vs. 15.2±7.1 h， P=0.008）， chest tube drainage（92.0±28.0 ml vs. 205.0±78.0 ml， P=0.000）， blood transfusion （0.8±1.6 U vs. 1.9±2.1 U， P=0.006）， length of ICU stay （14.0±8.0 h vs. 26.0±12.0 h， P=0.003） and length of hospital stay （14.8±4.6 d vs. 19.7±3.2 d， P=0.006）of the　mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety of mini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities， while the postoperative recovery　after mini-MVR is better than traditional MVR.

小儿先天性心脏病合并二尖瓣反流的外科治疗

目的　分析小儿先天性心脏病合并二尖瓣反流的病理生理特点，总结其外科治疗经验。 方法　回顾性分析1999年12月至2011年5月武汉亚洲心脏病医院新疆医院282例小儿先天性心脏病合并二尖瓣反流行二尖瓣成形手术患者的临床资料，男119例，女163例；年龄1个月 ～ 14 （4.2±3.8）岁；体重4.6～57.0 （18.0±17.6） kg。根据不同病变采取综合多种方法进行二尖瓣成形，主要手术方式为自体心包条环缩后瓣环150例（53.2%），内外交界缝合106例（37.6%）。同期行室间隔缺损修补术148例，房间隔缺损修补术67例，动脉导管未闭闭合术47例，部分型房室间隔缺损矫治术20例，法洛四联症根治术15例，右心室双出口根治术12例等。 结果　本组二尖瓣反流的病理改变中瓣环扩张最常见，其次为瓣叶裂隙，腱索和乳头肌延长最少见。呼吸机辅助呼吸时间（20.6±30.1） h，住院时间（22.4±8.8） d。围术期无死亡，发生一过性血红蛋白尿3例，早期发生低心排血量15例，行短期腹膜透析10例，经相应治疗后好转，均顺利出院。随访282例，随访时间7个月至11年。随访期间再次行二尖瓣置换术2例，前向血流（1.3±0.4） m/s，无二尖瓣狭窄。二尖瓣反流2级48例（17.0%），3 ～4级12例（4.3%）；左心室射血分数在正常范围内。 结论　小儿先天性心脏病合并二尖瓣反流患者行二尖瓣成形术，中期结果满意，自体心包条环缩后瓣环不会限制瓣环的发育。