Retrospectively Analyze Of Mitral Regurgitation In 52 Cases

Objective:To retrospectively analyze the clinical effect of 52 cases of mitral valvuloplasty in the treatment of mitral regurgitation in adults.Methods:The clinical data of 52 patients undergoing mitral valvuloplasty in our hospital from January 2016 to December 2018 were analyzed retrospectively.There were 33 males(63.5%)and 19 females(36.5%).The age of the patients ranged from 23-74(53±12.33)years old.Echocardiographic examination before operation:left atrial diameter(LAD)was 46.47±7.86(32.0~69.2)mm,left ventricular end-diastolic diameter(LVEDD)was 50.92±8.40(31.4~70.9)mm.About degree of mitral regurgitation(MR):there were 1 case of mild MR,14 cases of moderate MR and 37 cases of severe MR before operation.Mitral regurgitation area was 10.86±4.33(3~18.5)cm~2,left ventricular ejection fraction(LVEF)was 58.88%±9.82%(36.8%~77.9%).According to the cause of the disease,there were 35 cases of mitral valve prolapse,14 cases of congenital heart disease(including 9 cases of atrial septal defect,1 case of ventricular septal defect,3 cases of partial atrioventricular septal defect,and 1 case of patent ductus arteriosus),2cases of coronary heart disease,2 cases of infective endocarditis,and 1case of left atrial myxoma.Preoperative cardiac function grading (NYHA):12 case was in class?,29 cases in?,and 11 cases in class?.Mitral valvuloplasty methods:valvuloplasty was performed first for the changes of valvular and subvalvular structure,and then for annuloplasty:Prosthetic mitral ring was implanted in all 52 patients.Aortic valve replacement was performed in 9 cases,tricuspid valvuloplasty in 26 cases,congenital heart disease in 14 cases(including atrial septal defect repair in 9 cases,ventricular septal defect repair in 1case,partial atrioventricular septal defect correction in 3 cases and ductus arteriosus closure in 1 case),coronary artery bypass grafting in 2 cases,radiofrequency ablation in 4 cases and left atrial myxoma removal in 1case.The regurgitation and opening and closing of the valve were observed by intraoperative water injection test,and the opening and closing of the valve were observed by water injection again after the correction was completed.The valve opening and closing and valve function were evaluated by transesophageal echocardiography after cardioversion to ensure that the regurgitation area was smaller than 3cm~2and no mitral stenosis was found.Results:The effect of saline injection tests was satisfactory.There was no obvious stenosis of mitral valve after cardioversion by transesophageal echocardiography,the degree of regurgitation was no or trace MR,and there was no death during perioperative period.Postoperative echocardiography showed that the indexes were significantly improved:the left atrial diameter(LAD)was 37.09±6.94(20.3~59.3)mm,left ventricular end-diastolic diameter was(LVEDD)45.23±7.14(31.2~62.8)mm,the area of mitral regurgitation was 1.11±1.10(0~3.30)cm~2,and the left ventricular ejection fraction(LVEF)was 63.49%±8.88%(37.8%~81%).There was a significant difference in statistics.All of 52 cases were followed up for 3~36months.The cardiac functional classification(NYHA)of follow-up patients:38 cases in class I,and 14 cases in class?.There was no death and secondary operation in the whole group.Echocardiography showed no or trace MR in 40 cases,mild MR in 12 cases.There were no serious complications such as mitral regurgitation aggravation,valve avulsion,thrombosis,renal failure and endocarditis occurred during the follow-up period.Conclusion:Mitral valvuloplasty has achieved good clinical results,it's an effective method to treat mitral regurgitation.The application of prosthetic mitral ring in mitral valvuloplasty is an indispensable part of mitral valvuloplasty.The effect of mitral valvuloplasty can be confirmed by saline injection tests and transesophageal echocardiography.