Mitral Valvuloplasty For The Treatment Of Mitral Regurgitation In20Cases

Objective:To summarize the clinical experience and analyze the clinical effect of the mitral insufficiency treated with mitral valvuloplasty, help for the clinical practice.Methed:A total of20consecutive patients,11male and9female, with mitral valve insufficiency whom undertaken mitral valvuloplasty from January2003to March2011in our hospital were summarized retrospectively. The mean age was (37.7±17.6) years. Accord to the etiological classification:12of rheumatic mitral valve disease,6of degenerative mitral valve disease, and2of infective endocarditis. Preoperative heart function(NYHA) indicated that5patients in class Ⅱ,13in class Ⅲ and2in class Ⅳ.Preoperative transthoracic ultrasound heartbeat graph display:left atrial diastolic diameter31～66(46.7±8.8)mm, left ventricular end diastolic diameter39～73(57.8±9.3)mm, left ventricular end systolic diameter23～60(36.9±9.5)mm, EF33.3～79.5(66.3±9.6)%. Mitral valve regurgitation:moderate regurgitation in8cases and severe regurgitation in12cases. Anterior mitral valve prolapse in11cases, which rupture of chordae tendineae in1, and valve leaflet perforation in1; Posterior mitral valve prolapse in5cases and vegetations in1; Double valve prolapse in2cases, which tendon rupture in2. Method of mitral valvuloplasty: artificial chordae implantations and artificial valve ring in2cases, closure of the commissure in1, leaflet resection in10, edge to edge mitral valve plasty in3, repair of endocarditic lesions in1, folding technique of mitral valve in1.Result:During the operation, the results of injection test were satisfactory without or little mitral valve regurgitation was observed by transesophageal echocardiography, Apparent flow was not observed under observation of beating heart. Perioperative period had no deaths. There was1cases low cardiac output syndrome and1cases of arrhythmia after the operation; Follow-up, ranged from3to96months,20patients with12months were to our hospital outpatient appointment, postoperative echocardiography evaluation showed that no regurgitation or trace in12, little in6, modeatre in2.18patients were to our hospital outpatient appointment ranged from12to96months. There were deaths in1case, of which1case died of heart failure. The cardiac function is (NYHA): class I in10cases, class II in5cases, class III in1class, and class IV in1case. Because mitral regurgitation recurrence,3cases had valve replacement. Mitral regurgitation recurrence operation again mitral valve replacement in patients with3casesConclusion:Mitral valve angioplasty was an effective and safe surgical method for treatment of mitral regurgitation. Flexibly utilizing mitral valve angioplasty, according to the different characteristics of pathologieal changes of mitral valve, and grasp the strict operation indications, may achieve satisfactory effect. Intraoperative transesophageal ultrasound heartbeat graph and water injection test for judging the operation results provide useful help. In the absence of intraoperative transesophageal echocardiography monitoring conditions, and be direct observation on beating heart method for evaluation of the effect of mitral valvuloplasty.