二尖瓣削薄成形术治疗风湿性二尖瓣疾病的中期疗效

Mid-Term Efficacy of Mitral Valvuloplasty for Rheumatic Mitral Valve Disease

摘要: 目的：风湿性二尖瓣疾病是风湿性心脏病(RHD)最常见的瓣膜病变，本研究旨在探讨二尖瓣削薄成形术(MVP)治疗风湿性二尖瓣疾病的中期疗效。方法：收集本中心在2016年4月至2024年6月期间，经MVP治疗的22例风湿性二尖瓣疾病患者的临床资料及术后随访结果。其中1例因二尖瓣瓣叶及腱索融合、钙化严重中转为二尖瓣置换术(MVR)。按年龄、主动脉阻断时间、体外循环时间、ICU停留时间相近的原则，随机选30例经MVR治疗的风湿性二尖瓣疾病患者。比较两组患者在随访过程的临床症状缓解情况、超声心动图、心电图等结果。结果：本研究共纳入51例患者。MVP组(21例)平均随访时间为34个月(7月~106月)，平均年龄为50.57 ± 9.95岁。MVR组(3例)平均随访时间为31个月(9月~101月)，平均年龄为55.33 ± 8.31岁。MVP组术前及随访结果与MVR组相似。两组在年龄、体外循环时间、主动脉阻断时间、病死率、二尖瓣狭窄(MS)及二尖瓣反流(MR)上的差异无统计学意义(P > 0.05)，在术前、术后左心房内径、左心室舒张期末内径、左心室射血分数、二尖瓣最大反流速度、跨瓣压差的差异也没有统计学意义(P > 0.05)。结论：对于风湿性二尖瓣疾病患者，MVP治疗的中期疗效与MVR相似，且MVP有利于改善心功能，术后出血和栓塞风险更低。

Abstract: Objective: Rheumatic mitral valve disease represents the most prevalent valvular lesion in rheumatic heart disease (RHD). The present study is designed to investigate the mid-term therapeutic efficacy of mitral valve plasty (MVP) for treating rheumatic mitral valve disease. This study evaluates the mid-term efficacy of mitral valvuloplasty (MVP) for this condition. Methods: From April 2016 to June 2024, 22 patients with rheumatic mitral valve disease who underwent MVP at our center were studied. Their clinical data and follow-up results were analyzed. One patient required conversion to mitral valve replacement (MVR) due to severe mitral leaflet and chordal fusion and calcification. For comparison, 30 RHD patients treated with MVR were randomly selected, matched by age, aortic cross-clamp time, cardiopulmonary bypass time, and ICU stay. Outcomes including clinical symptom relief, echocardiography, and ECG results during follow-up were compared between the two groups. Results: A total of 51 patients were included. The MVP group (21 patients) had a mean follow-up of 34 months (7~106 months) and a mean age of 50.57 ± 9.95 years. The MVR group (30 patients) had a mean follow-up of 31 months (9~101 months) and a mean age of 55.33 ± 8.31 years. Preoperative and follow-up results were similar between the MVP and MVR groups. There were no significant differences in age, cardiopulmonary bypass time, aortic cross-clamp time, mortality, mitral stenosis (MS), and mitral regurgitation (MR) (P > 0.05). There were also no significant differences in left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, maximum mitral regurgitation velocity, and transvalvular pressure gradient before and after surgery (P > 0.05). Conclusion: For patients with rheumatic mitral valve disease, MVP offers mid-term efficacy comparable to MVR, with added benefits of better heart function improvement and lower postoperative bleeding and thrombosis risks.