Matsumoto T, Kado H, Masuda M, Shiokawa Y, Fukae K, Morita S, Yasui H
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, and the Department of Cardiac Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Thorac Cardiovasc Surg. 1999 Jul;118(1):94-8. doi: 10.1016/S0022-5223(99)70147-9.
There are an increasing number of reports concerning mitral valve repair by reconstructing the chordae tendineae with the use of expanded polytetrafluoroethylene sutures in adults. However, little information is available about application or results of this technique in children.
Between January 1995 and December 1997, 16 children who had from moderate to severe mitral regurgitation mainly as the result of a prolapse of the anterior leaflet (age range, 5 months-12.8 years) underwent mitral valve repair by reconstruction of artificial chordae. Either unilateral or bilateral Kay-Reed annuloplasty was also performed to correct annular dilatation in all patients.
No operative death or morbidity was observed. Before discharge, immediate postoperative echocardiography showed less than trivial mitral regurgitation in all patients. The follow-up was complete in all cases by a clinical examination and serial echocardiograms, and the median follow-up period was 14.8 months (range, 1.3-26.4 months). There were no valve-related events during the entire follow-up period. The degree of mitral regurgitation, estimated by echocardiography performed at recent follow-up period, was none in 5 patients, trivial in 10 patients, and mild in 1 patient. The diastolic and systolic dimensions of the left ventricle decreased and were 95.0% and 96.2% of the normal values, respectively.
Although further investigations and long-term results are still called for, mitral valve repair by reconstruction of the artificial chordae was found to be safe and effective even in infants and children.
关于在成人中使用膨体聚四氟乙烯缝线重建腱索进行二尖瓣修复的报道越来越多。然而，关于该技术在儿童中的应用或结果的信息却很少。
在1995年1月至1997年12月期间，16名主要因前叶脱垂导致中度至重度二尖瓣反流的儿童（年龄范围为5个月至12.8岁）接受了人工腱索重建的二尖瓣修复术。所有患者均进行了单侧或双侧Kay-Reed瓣环成形术以纠正瓣环扩张。
未观察到手术死亡或并发症。出院前，术后即刻超声心动图显示所有患者的二尖瓣反流均小于微量。所有病例均通过临床检查和系列超声心动图进行了完整的随访，中位随访期为14.8个月（范围为1.3至26.4个月）。在整个随访期间未发生与瓣膜相关的事件。在最近的随访期通过超声心动图评估的二尖瓣反流程度，5例患者无反流，10例患者微量反流，1例患者轻度反流。左心室的舒张和收缩维度减小，分别为正常值的95.0%和96.2%。
尽管仍需要进一步研究和长期结果，但发现即使在婴幼儿和儿童中，通过重建人工腱索进行二尖瓣修复也是安全有效的。
