目的 嘗試在非體外循環(huán)冠狀動脈旁路移植術（OPCAB）期間對輕至中度缺血性二尖瓣反流（IMR）患者采用自制二尖瓣成形裝置進行外科處理，并評估其療效。方法 回顧性分析自 2009年 9月至 2011年 8月北京安貞醫(yī)院 6例輕至中度 IMR患者（男 4例、女 2例，年齡 52～73歲）在 OPCAB期間采用自制二尖瓣成形裝置進行二尖瓣成形的臨床資料。在處理 IMR前及處理后通過經(jīng)食管超聲心動圖測定 IMR程度、二尖瓣瓣環(huán)前后徑、左心室短軸徑、左心室長軸徑、左心室球形指數(shù)（左心室短軸徑 /左心室長軸徑）等；通過 Swan-Ganz導管測量并記錄主動脈平均壓、肺動脈平均壓和中心靜脈壓等。比較圍術期相關心功能指標。結果 無住院死亡。二尖瓣成形后 IMR均消失、二尖瓣瓣環(huán)前后徑［（3.43±0.08）cm vs.（3.68±0.08）cm；t=5.430，P=0.001］、左心室短軸徑［（4.80±0.21） cm vs.（5.53±0.11）cm；t=7.530, P=0.001］和左心室球形指數(shù)（ 0.64±0.02 vs. 0.74±0.01；t=11.110，P=0.002）均較處理前明顯減??；左心室長軸徑無明顯變化（ P＞ 0.05）；術中血流動力學指標無明顯變化。術后 3個月 6例患者（隨訪率 100%）均在門診復查，均無自主臨床癥狀，心功能均改善至Ⅰ級（ NYHA）。超聲心動圖提示：二尖瓣無反流 4例，有微量反流 2例。結論 在 OPCAB期間采用自制二尖瓣成形裝置成形治療 IMR，直接完成了左心室塑型，規(guī)避了體外循環(huán)風險，即刻療效確切，對循環(huán)指標影響甚小，有一定的臨床應用價值。
引用本文： 于洋,顧承雄,李京倖等. 非體外循環(huán)下采用自制二尖瓣成形裝置手術治療輕至中度缺血性二尖瓣關閉不全. 中國胸心血管外科臨床雜志, 2012, 19(3): 244-247. doi: 復制
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| 2. | Lamas GA, Mitchell GF, Flaker GC, et a1．Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators.Circulation, 1997, 96（3）：827-833．. |
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| 9. | Agricola E, Oppizzi M, Pisani M, et al. Ischemic mitral regurgitation： mechanisms and echocardiographic classification. Eur J Echocardiogr, 2008, 9（2）：207-221. |
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| 11. | 吳若彬, 鄭少憶, 郭惠明, 等. 冠心病合并缺血性二尖瓣關閉不全的處理方法. 中華胸心血管外科雜志，2004, 20（5）：271-273. |
| 12. | Marasco SF. Ischaemic mitral regurgitation and the role of surgical intervention. Heart Lung Circ, 2008, 17（ Suppl 4）：S14-S20. |
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| 14. | Forouzannia SK, Abdollahi MH, Mirhosseini SJ, et a1. Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery. Acta Med Iran, 2011, 49（7）：414-419. |
| 15. | Liel-Cohen N, Guerrero JL, Otsuji Y, et a1. Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation： insights from 3-dimensional echocardiography.Circulation, 2000, 101（23）：2756-2763. |
| 16. | Bach DS, Deeb GM, Bolling SF. Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation.Am J Cardiol, 1995, 76（7）：508-512. |
| 17. | Lancellotti P, Troisfontaines P, Toussaint AC, et a1. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation, 2003, 108（14）：1713-1717. |
| 18. | Campwala SZ，Bansal RC，Wang N，et a1．Mitral regurgitation progression following isolated coronary artery bypass surgery： frequency, risk factors, and potential prevention strategies.Eur J Cardiothorac Surg, 2006, 29（3）：348-353．. |
- 1. Magne J, Sénéchal M, Dumesnil JG, et a1. Ischemic mitral regurgitation： a complex multifaceted disease. Cardiology, 2009, 112（4）：244-259.
- 2. Lamas GA, Mitchell GF, Flaker GC, et a1．Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators.Circulation, 1997, 96（3）：827-833．.
- 3. Fattouch K, Sampognaro R, Speziale G, et a1. Impact of moderate ischemic mitral regurgitation after isolated coronary artery bypass grafting.Ann Thorac Surg, 2010, 90（4）：1187-1194.
- 4. Aklog L, Filsoufi F, Flores KQ, et a1. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation, 2001, 104（12 Suppl 1）：I68-I75.
- 5. Bouma W, van der Horst IC, Wijdh-den Hamer IJ, et a1. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches. Eur J Cardiothorac Surg, 2010, 37（1）：170-185.
- 6. 于洋, 顧承雄, 韋華, 等. OPCAB同時行左心室室壁瘤縫縮術206例.中華胸心血管外科雜志, 2007, 23（3）：154-155.
- 7. Burch GE, De Pasquale NP, Phillips JH. Clinical manifestations of papillary muscle dysfunction. Arch Intern Med, 1963, 112：112-117.
- 8. Mittal AK, Langston M Jr, Cohn KE, et a1. Combined papillary muscle and left ventricular wall dysfunction as a cause of mitral regurgitation. An experimental study. Circulation, 1971, 44（2）：174-180.
- 9. Agricola E, Oppizzi M, Pisani M, et al. Ischemic mitral regurgitation： mechanisms and echocardiographic classification. Eur J Echocardiogr, 2008, 9（2）：207-221.
- 10. 紀廣玉, 徐志云, 鄒良建，等. 冠心病合并慢性中度缺血性二尖瓣關閉不全的外科治療.中國胸心血管外科臨床雜志, 2007, 14（4）：248-251.
- 11. 吳若彬, 鄭少憶, 郭惠明, 等. 冠心病合并缺血性二尖瓣關閉不全的處理方法. 中華胸心血管外科雜志，2004, 20（5）：271-273.
- 12. Marasco SF. Ischaemic mitral regurgitation and the role of surgical intervention. Heart Lung Circ, 2008, 17（ Suppl 4）：S14-S20.
- 13. Grossi EA，Crooke GA，DiGiorgi PL，et a1．Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. Circulation, 2006, 114（Suppl 1）：1573-1576．.
- 14. Forouzannia SK, Abdollahi MH, Mirhosseini SJ, et a1. Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery. Acta Med Iran, 2011, 49（7）：414-419.
- 15. Liel-Cohen N, Guerrero JL, Otsuji Y, et a1. Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation： insights from 3-dimensional echocardiography.Circulation, 2000, 101（23）：2756-2763.
- 16. Bach DS, Deeb GM, Bolling SF. Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation.Am J Cardiol, 1995, 76（7）：508-512.
- 17. Lancellotti P, Troisfontaines P, Toussaint AC, et a1. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation, 2003, 108（14）：1713-1717.
- 18. Campwala SZ，Bansal RC，Wang N，et a1．Mitral regurgitation progression following isolated coronary artery bypass surgery： frequency, risk factors, and potential prevention strategies.Eur J Cardiothorac Surg, 2006, 29（3）：348-353．.