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· 臨床研究·
作者單位:200032 上海,復旦大學附屬中山醫(yī)院 上海市心血管病
研究所超聲心動圖室
超聲心動圖評價二尖瓣環(huán)成形術中應用
三種不同人工瓣環(huán)后的中期療效
潘翠珍 舒先紅 周密 施月芳 潘文明 程蕾蕾 葛均波 陳灝珠
【摘要】 目的 超聲心動圖評價二尖瓣環(huán)成形術中應用三種不同人工瓣環(huán)的中期療效 ,為臨床上合
理選用人工二尖瓣環(huán)提供參考。方法 心外科施行二尖瓣成形術中植入 Carpentier 硬環(huán)、 Duran 閉合環(huán)、Cosgrove開放軟環(huán)的 69 例患者 ,Carpentier 環(huán)組(CA 組) 19 例 , Duran 環(huán)組(DU 組) 28 例 ,Cosgrove 環(huán)組
(CO組) 22 例 ,均為二尖瓣關閉不全患者。記錄所有患者術前、術后二維超聲心動圖資料 ,包括二尖瓣反流
程度、二尖瓣跨瓣壓差、跨瓣最大流速、二尖瓣環(huán)收縮末和舒張末橫徑、二尖瓣環(huán)收縮末和舒張末縱徑、左
室射血分數、左房內徑、肺動脈收縮壓、左室收縮末容積、左室舒張末容積、室壁增厚率(ΔT %) 。15 例患
者術后隨訪實時三維超聲心動圖 ,包括二尖瓣環(huán)舒張末、收縮末面積和面積變化率。結果 共隨訪到 68
例患者 ,隨訪率 98. 5 % ,平均隨訪時間為(9. 3 ±7. 4)個月。術后三組二尖瓣反流程度均較術前顯著下降
( P < 0. 001) ,二尖瓣跨瓣壓差及二尖瓣血流速度較術前升高( P < 0. 05 , P < 0. 001) ,二尖瓣環(huán)直徑均較
術前明顯縮短( P < 0. 05) 。術后人工二尖瓣環(huán)收縮末與舒張末直徑變化率比較 ,橫徑 CA 組小于其他兩
組 ,縱徑 CA組小于 DU 組 ,DU 組小于 CO組(均 P < 0. 05) 。實時三維超聲檢測二尖瓣環(huán)面積變化率 ,CA
組小于其他兩組( P < 0. 05) ,DU 組與 CO組差異無顯著性意義( P > 0. 05) 。術后左房內徑、肺動脈收縮
壓、左室容積均較術前下降 ,ΔT %升高(均 P < 0. 05) 。結論 應用軟環(huán)能更好地保留二尖瓣環(huán)的舒縮功
能 ,而且 Cosgrove軟環(huán)可能優(yōu)于 Duran軟環(huán)。Cosgrove軟環(huán)改善心功能的作用可能優(yōu)于 Carpentier 硬環(huán)和
Duran軟環(huán)。
【關鍵詞】 超聲心動描記術;二尖瓣;心臟瓣膜 ,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 · 中華超聲影像學雜志2004 年5 月第13 卷第5 期 Chin J Ult rasonogr ,May 2004 ,Vol 13 ,No. 5
? 1995-2005 Tsinghua Tongfang Optical Disc Co., Ltd. All rights reserved. 臨床使用的人工瓣環(huán)主要有半硬質環(huán)、彈性閉合
環(huán)和彈性開放環(huán) ......
作者單位:200032 上海,復旦大學附屬中山醫(yī)院 上海市心血管病
研究所超聲心動圖室
超聲心動圖評價二尖瓣環(huán)成形術中應用
三種不同人工瓣環(huán)后的中期療效
潘翠珍 舒先紅 周密 施月芳 潘文明 程蕾蕾 葛均波 陳灝珠
【摘要】 目的 超聲心動圖評價二尖瓣環(huán)成形術中應用三種不同人工瓣環(huán)的中期療效 ,為臨床上合
理選用人工二尖瓣環(huán)提供參考。方法 心外科施行二尖瓣成形術中植入 Carpentier 硬環(huán)、 Duran 閉合環(huán)、Cosgrove開放軟環(huán)的 69 例患者 ,Carpentier 環(huán)組(CA 組) 19 例 , Duran 環(huán)組(DU 組) 28 例 ,Cosgrove 環(huán)組
(CO組) 22 例 ,均為二尖瓣關閉不全患者。記錄所有患者術前、術后二維超聲心動圖資料 ,包括二尖瓣反流
程度、二尖瓣跨瓣壓差、跨瓣最大流速、二尖瓣環(huán)收縮末和舒張末橫徑、二尖瓣環(huán)收縮末和舒張末縱徑、左
室射血分數、左房內徑、肺動脈收縮壓、左室收縮末容積、左室舒張末容積、室壁增厚率(ΔT %) 。15 例患
者術后隨訪實時三維超聲心動圖 ,包括二尖瓣環(huán)舒張末、收縮末面積和面積變化率。結果 共隨訪到 68
例患者 ,隨訪率 98. 5 % ,平均隨訪時間為(9. 3 ±7. 4)個月。術后三組二尖瓣反流程度均較術前顯著下降
( P < 0. 001) ,二尖瓣跨瓣壓差及二尖瓣血流速度較術前升高( P < 0. 05 , P < 0. 001) ,二尖瓣環(huán)直徑均較
術前明顯縮短( P < 0. 05) 。術后人工二尖瓣環(huán)收縮末與舒張末直徑變化率比較 ,橫徑 CA 組小于其他兩
組 ,縱徑 CA組小于 DU 組 ,DU 組小于 CO組(均 P < 0. 05) 。實時三維超聲檢測二尖瓣環(huán)面積變化率 ,CA
組小于其他兩組( P < 0. 05) ,DU 組與 CO組差異無顯著性意義( P > 0. 05) 。術后左房內徑、肺動脈收縮
壓、左室容積均較術前下降 ,ΔT %升高(均 P < 0. 05) 。結論 應用軟環(huán)能更好地保留二尖瓣環(huán)的舒縮功
能 ,而且 Cosgrove軟環(huán)可能優(yōu)于 Duran軟環(huán)。Cosgrove軟環(huán)改善心功能的作用可能優(yōu)于 Carpentier 硬環(huán)和
Duran軟環(huán)。
【關鍵詞】 超聲心動描記術;二尖瓣;心臟瓣膜 ,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 · 中華超聲影像學雜志2004 年5 月第13 卷第5 期 Chin J Ult rasonogr ,May 2004 ,Vol 13 ,No. 5
? 1995-2005 Tsinghua Tongfang Optical Disc Co., Ltd. All rights reserved. 臨床使用的人工瓣環(huán)主要有半硬質環(huán)、彈性閉合
環(huán)和彈性開放環(huán) ......
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