Objective: To evaluate the clinical characteristics and prognosis of patients with mitral valve prolapse (MVP). Methods: We retrospectively analyzed the clinical characteristics and prognosis of 148 MVP patients who underwent mitral valve surgery in Fuwai hospital from January 2012 to December 2015.The patients were divided into mucoid degeneration group (52 cases) and without mucoid degeneration group(19 cases) according to pathological examination of leaflets and chordate. Results: The clinical symptoms of MVP patients included dyspnea (59.5%(88/148)), chest distress and pain (52.7%(78/148)), and palpitations (36.5% (54/148)). Mitral valve repair was performed in 144 cases (97.3%), and mitral valve replacement was performed in 4 cases (2.7%). Posterior leaflet prolapse was the most common form of MVP (68.9%, 102/148). Pathological examination revealed myxomatous degeneration in 73.2% patients (52/71), fibrosis in 8.5% patients (6/71), and fibrinoid necrosis in 8.5% patients (6/71). Patients with mucoid degeneration had less atrial fibrillation before surgery (5.8%(3/52) vs. 42.1%(8/19), P<0.01), smaller preoperative left atrium diameter ((43.2±6.5) mm vs. (48.2±8.9) mm, P<0.05), more posterior leaflet prolapse (94.2%(49/52) vs. 63.2%(12/19), P<0.01), redundant chordae (26.9%(14/52) vs. 0, P<0.05) and leaflet thickening (76.9%(40/52) vs. 52.6%(10/19), P<0.05) when compared with patients without mucoid degeneration.Echocardiography examination at the postoperative follow-up of 39.0(22.3, 57.0) months revealed smaller left atrium diameter((38.5±7.1) mm vs. (45.3±8.3) mm, P<0.01), left ventricular end-diastolic diameter ((48.9±6.2) mm vs. (57.5±7.6) mm, P<0.01), reduced left ventricular ejection fraction ((61.2±7.1)% vs. (65.1±6.2)%, P<0.01) and less moderate or severe mitral regurgitation (1.4%(2/148) vs. 100.0%(148/148), P<0.01) compared with the corresponding preoperative values. Conclusions: Dyspnea is the main symptom, and mucoid degeneration characterized by redundant chordae and leaflet thickening are the main pathological features of MVP patients.The surgical treatment of MVP patients is related with satisfactory outcome results.
目的： 探讨二尖瓣脱垂(MVP)患者的临床特点及预后。 方法： 选取2012年1月至2015年12月在阜外医院行外科手术的MVP患者148例，回顾性分析其临床特点，并在术后进行随访。根据瓣叶和腱索病理检查结果，将其中71例MVP患者分为黏液样变性组(52例)和非黏液样变性组(19例)。 结果： MVP患者的临床症状中呼吸困难占59.5%(88/148)，胸闷和胸痛占52.7%(78/148)，心悸占36.5%(54/148)。采用的手术方式包括二尖瓣修复成形术144例(97.3%)和二尖瓣瓣膜置换术4例(2.7%)。MVP患者中二尖瓣后叶脱垂占68.9%(102/148)，病理类型中黏液样变性占73.2%(52/71)，纤维化变性占8.5%(6/71)，纤维素样坏死占8.5%(6/71)。与非黏液样变性组比较，黏液样变性组术前合并心房颤动比率较低[5.8%(3/52)比42.1%(8/19)，P<0.01]，术前左心房内径较小[(43.2±6.5) mm比(48.2±8.9) mm，P<0.05]，后叶脱垂、腱索延长和瓣叶增厚比率均较高[分别为94.2%(49/52)比63.2%(12/19)，P<0.01；26.9%(14/52)比0，P<0.05；76.9%(40/52)比52.6%(10/19)，P<0.05]。术后随访39.0(22.3，57.0)个月，随访期间超声心动图显示左心房内径[(38.5±7.1) mm比(45.3±8.3) mm，P<0.01]、左心室舒张末期内径[(48.9±6.2) mm比(57.5±7.6) mm，P<0.01]、左心室射血分数[(61.2±7.1)%比(65.1±6.2)%，P<0.01]和二尖瓣中量以上反流比率[1.4%(2/148)比100.0%(148/148)，P<0.01]均小于术前。 结论： MVP患者的临床症状以呼吸困难为主，黏液样变性是MVP最主要的病理类型，腱索延长和瓣叶增厚是其特征性改变。MVP患者通过外科手术可取得满意的治疗效果。.
Keywords: Cardiac surgical procedures; Mitral valve prolapse; Prognosis.