改良人工腱索联合瓣环成形术在二尖瓣脱垂修复中的应用及远期随访结果
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摘要
目的探索改良的人工腱索技术联合人工瓣环成形术修复二尖瓣前叶或/和后叶脱垂引起的二尖瓣关闭不全及其近、远期随访效果。方法回顾性分析2006年1月至2014年6月我院应用改良人工腱索技术联合人工瓣环成形术修复二尖瓣前叶或/和后叶脱垂引起的重度二尖瓣关闭不全112例患者的临床资料,其中男69例、女43例,年龄5~73(51.4±14.4)岁。术中在脱垂瓣叶对应的乳头肌上将不带垫片的膨体聚四氟乙烯(ePTFE)缝线作U型缝合,两头的针线则均在距缘3~5 mm处缝合于脱垂瓣叶的游离缘,先将每根线在脱垂的瓣缘缝两针,在置入C型二尖瓣成形环后,通过左心室的反复注水试验,调整人工腱索的长度至最佳位置,直至完全纠正瓣叶脱垂和二尖瓣反流,最后每根针线再在瓣缘缝一针,打结固定。结果全组患者均成功行二尖瓣成形术,每例患者平均植入1~3(2.4±0.7)根e PTFE人工腱索。二尖瓣成形术后,术中经胸超声心动图提示78例患者无二尖瓣反流,34例患者为轻度二尖瓣反流。出院时,复查经胸超声心动图提示二尖瓣无反流72例,轻度反流39例,轻中度反流1例。与术前相比,术后左心室舒张期末内径(LVEDD)明显缩小[(58.6±8.7)mm vs.(50.7±6.3)mm],P<0.001]。术后随访3~105(41.5±24.8)个月时,无反流或轻度反流93例,轻中度反流16例,中度反流3例。术后5年,中度以上二尖瓣关闭不全免除率为95.1%±3.0%。结论应用该改良人工腱索技术联合人工瓣环成形术修复瓣叶脱垂引起的二尖瓣关闭不全,操作简单易行,人工腱索的调整、固定方便,近、远期效果良好。
Objective To explore the result of of modified artificial chordae technique and annuloplasty in mitral valvuloplasty for mitral leaflet prolapse.Methods We retrospectively analyzed the clinical data of 112 patients underwent mitral valve repair with artificial chordae(expanded polytetrafluoroethylene,e PTFE) and annuloplasty in our hospital from January 2006 through June 2014.There were 69 males and 43 females at age of 5-73(51.4±14.4) years.The double-armed e PTFE chordae was fixed at papillary muscle head using U shaped suture without pledget and passed through the prolapsing portion of leaflet twice.Then,annuloplasty was performed and correct chordal length was adjusted.After that,the chordae was passed through prolapsing scallop one more time and tied.Results Average of 2.4±0.7(range from 1 to 3) ePTFE artificial chordaes were implanted in each patient.Intra-operative transthoracic echocardiography showed no mitral regurgitation(MR) in 78 patients and tricuspid regurgitation in 34 patients.At discharge,no MR was in 72 patients,trivial MR in 39 patients,and mild MR in 1 patient.At end of follow-up of 41.5±24.8 months,moderate MR was in 3 patients.The freedom from moderate or severe regurgitation at 5 years after mitral valve repair was 95.1%±3.0%.Conclusion This modified artificial chordae technique and annuloplasty are safe,simple,and effective in mitral valvuloplasty for mitral leaflet prolapsed.And the early and long-term results are satisfactory.
Objective To explore the result of of modified artificial chordae technique and annuloplasty in mitral valvuloplasty for mitral leaflet prolapse.Methods We retrospectively analyzed the clinical data of 112 patients underwent mitral valve repair with artificial chordae(expanded polytetrafluoroethylene,e PTFE) and annuloplasty in our hospital from January 2006 through June 2014.There were 69 males and 43 females at age of 5-73(51.4±14.4) years.The double-armed e PTFE chordae was fixed at papillary muscle head using U shaped suture without pledget and passed through the prolapsing portion of leaflet twice.Then,annuloplasty was performed and correct chordal length was adjusted.After that,the chordae was passed through prolapsing scallop one more time and tied.Results Average of 2.4±0.7(range from 1 to 3) ePTFE artificial chordaes were implanted in each patient.Intra-operative transthoracic echocardiography showed no mitral regurgitation(MR) in 78 patients and tricuspid regurgitation in 34 patients.At discharge,no MR was in 72 patients,trivial MR in 39 patients,and mild MR in 1 patient.At end of follow-up of 41.5±24.8 months,moderate MR was in 3 patients.The freedom from moderate or severe regurgitation at 5 years after mitral valve repair was 95.1%±3.0%.Conclusion This modified artificial chordae technique and annuloplasty are safe,simple,and effective in mitral valvuloplasty for mitral leaflet prolapsed.And the early and long-term results are satisfactory.
引文
1 Ibrahim M,Rao C,Savvopoulou M,et al.Outcomes of mitral valve repair using artii cial chordae.Eur J Cardiothorac Surg,2014,45(4):593-601.
2 Bortolotti U,Milano AD,Frater RW.Mitral valve repair with artii cial chordae:a review of its history,technical details,long-term results,and pathology.Ann h orac Surg,2012,93(2):684-691.
3 Fattouch K,Bianco G,Sbraga F,et al.Simple,safe and easy technique to ensure the correct length of artii cial chordae in mitral valve repair.Ann h orac Surg,2007,83(5):1902-1903.
4 Bizzarri F,Tudisco A,Ricci M,et al.Different ways to repair the mitral valve with artii cial chordae:a systematic review.J Cardiothorac Surg,2010,5:22.
5 Lange R,Guenther T,Noebauer C,et al.Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leal et prolapse.Ann h orac Surg,2010,89(4):1163-1170.
6 Gillinov AM,Cosgrove DM.Mitral valve repair for degenerative disease.J Heart Valve Dis,2002,11(Suppl 1):S15-S20.
7 Morimoto H,Tsuchiya K,Nakajima M,et al.Mitral valve repair for anterior leal et prolapse:surgical techniques review and 16-year follow-up results.J Card Surg,2008,23(5):426-430.
8 Aubert S,Barreda T,Acar C,Leprince P,et al.Mitral valve repair for commissural prolapse:surgical techniques and long term results.Eur J Cardiothorac Surg,2005,28(3):443-447.
9 David TE.Replacement of chordae tendineae with expanded polytetral uoroethylene sutures.J Card Surg,1989,4(4):286-290.
10 David TE,Bos J,Rakowski H.Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures.J Thorac Cardiovasc Surg,101(3):495-501.
11 David TE.Artii cial chordae.Semin h orac Cardiovasc Surg,2004,16(2):161-168.
12 Kasegawa H,Shimokawa T,Shibazaki I,et al.Mitral valve repair for anterior leal et prolapse with expanded polytetral uoroethylene sutures.Ann h orac Surg,2006,81(5):1625-1631.
13 Cagli K.A simple method of making artificial chordal loops for mitral valve repair.Ann h orac Surg,2010,89(2):e12-e14.
14 Chang JP,Kao CL.Slit stent technique for ensuring the correct length of artii cial chordae in mitral repair.J Card Surg,2011,26(3):259-260.
15 Mandegar MH,Yousefnia MA,Roshanali F.Preoperative determination of artii cial chordae length.Ann h orac Surg,2007,84(2):680-682.
16 Moorjani N,Viola N,Janusauskas V,et al.Adjusting the length of artii cial polytetral uoroethylene chordae in mitral valve repair by a single loop technique.J Thorac Cardiovasc Surg,2009,138(6):1441-1442.
17 von Oppell UO,Mohr FW.Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops.Ann h orac Surg,2000,70(6):2166-2168.
18 Kudo M,Yozu R,Kokaji K,et al.Feasibility of mitral valve repair using the loop technique.Ann h orac Cardiovasc Surg,2007,13(1):21-26.
19 Soga Y,Nishimura K,Ikeda T,et al.Chordal-sparing mitral valve replacement using artii cial chordae tendineae for rheumatic mitral stenosis:experience of the“oblique”method.Artif Organs,2002,26(9):802-805.
20 Salvador L,Mirone S,Bianchini R,et al.A 20-year experience with mitral valve repair with artii cial chordae in 608 patients.J h orac Cardiovasc Surg,2008,135(6):1280-1287.
2 Bortolotti U,Milano AD,Frater RW.Mitral valve repair with artii cial chordae:a review of its history,technical details,long-term results,and pathology.Ann h orac Surg,2012,93(2):684-691.
3 Fattouch K,Bianco G,Sbraga F,et al.Simple,safe and easy technique to ensure the correct length of artii cial chordae in mitral valve repair.Ann h orac Surg,2007,83(5):1902-1903.
4 Bizzarri F,Tudisco A,Ricci M,et al.Different ways to repair the mitral valve with artii cial chordae:a systematic review.J Cardiothorac Surg,2010,5:22.
5 Lange R,Guenther T,Noebauer C,et al.Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leal et prolapse.Ann h orac Surg,2010,89(4):1163-1170.
6 Gillinov AM,Cosgrove DM.Mitral valve repair for degenerative disease.J Heart Valve Dis,2002,11(Suppl 1):S15-S20.
7 Morimoto H,Tsuchiya K,Nakajima M,et al.Mitral valve repair for anterior leal et prolapse:surgical techniques review and 16-year follow-up results.J Card Surg,2008,23(5):426-430.
8 Aubert S,Barreda T,Acar C,Leprince P,et al.Mitral valve repair for commissural prolapse:surgical techniques and long term results.Eur J Cardiothorac Surg,2005,28(3):443-447.
9 David TE.Replacement of chordae tendineae with expanded polytetral uoroethylene sutures.J Card Surg,1989,4(4):286-290.
10 David TE,Bos J,Rakowski H.Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures.J Thorac Cardiovasc Surg,101(3):495-501.
11 David TE.Artii cial chordae.Semin h orac Cardiovasc Surg,2004,16(2):161-168.
12 Kasegawa H,Shimokawa T,Shibazaki I,et al.Mitral valve repair for anterior leal et prolapse with expanded polytetral uoroethylene sutures.Ann h orac Surg,2006,81(5):1625-1631.
13 Cagli K.A simple method of making artificial chordal loops for mitral valve repair.Ann h orac Surg,2010,89(2):e12-e14.
14 Chang JP,Kao CL.Slit stent technique for ensuring the correct length of artii cial chordae in mitral repair.J Card Surg,2011,26(3):259-260.
15 Mandegar MH,Yousefnia MA,Roshanali F.Preoperative determination of artii cial chordae length.Ann h orac Surg,2007,84(2):680-682.
16 Moorjani N,Viola N,Janusauskas V,et al.Adjusting the length of artii cial polytetral uoroethylene chordae in mitral valve repair by a single loop technique.J Thorac Cardiovasc Surg,2009,138(6):1441-1442.
17 von Oppell UO,Mohr FW.Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops.Ann h orac Surg,2000,70(6):2166-2168.
18 Kudo M,Yozu R,Kokaji K,et al.Feasibility of mitral valve repair using the loop technique.Ann h orac Cardiovasc Surg,2007,13(1):21-26.
19 Soga Y,Nishimura K,Ikeda T,et al.Chordal-sparing mitral valve replacement using artii cial chordae tendineae for rheumatic mitral stenosis:experience of the“oblique”method.Artif Organs,2002,26(9):802-805.
20 Salvador L,Mirone S,Bianchini R,et al.A 20-year experience with mitral valve repair with artii cial chordae in 608 patients.J h orac Cardiovasc Surg,2008,135(6):1280-1287.