Furukawa H, Tsuchiya K, Ogata K, Kabuto Y, Iida Y
Department of Cardiovascular Surgery, Yamanashi Prefectural Central Hospital, Japan.
Kyobu Geka. 1999 Nov;52(12):1005-9.
We evaluated a method of mitral valve plasty (MVP) for ischemic mitral regurgitation (IMR) by examining the morphological changes of the mitral valve. From November 1992 to May 1998, 8 patients (M : F = 4/4, age 44-79 years, mean age 65.1 years) with IMR underwent surgical repair. Preoperative mitral regurgitation (MR) was grade III of Sellers classification in 7 patients and grade IV in 1 patient. The cause of MR was mitral valve annular dilatation in 4 patients, mitral valve prolapse due to papillary muscle elongation in 2 patients, and partial papillary muscle rupture (PMR) in 2 patients. Cardiac surgery consisted of CABG + MVP in 7 patients and MVP in 1 patient. Mitral valve repair was separated into three types. Repair for annular dilatation consisted of commissuroplasty in 3 patients (2 patients Kay method, 1 patient Reed method) and ring annuloplasty using a Carpentier-Edwards ring (C-E ring) in 1 patient. Repair for papillary muscle elongation consisted of papillary muscle shortening and ring annuloplasty using a C-E ring. Repair for partial PMR consisted of papillary muscle implantation and ring annuloplasty for anterior leaflet prolapse in 1 patient, and quadrangular resection, posterior leaflet plasty (McGoon method) and ring annuloplasty in 1 patient. There was no hospital death. Postoperative outcome was 6 patients with no MR and 2 patients with grade II MR, but they were well-controlled with medication. Based on the morphological changes of the mitral valve, it is considered that MVP for IMR is an effective and recommended procedure.
我们通过检查二尖瓣的形态变化，评估了一种用于缺血性二尖瓣反流（IMR）的二尖瓣成形术（MVP）方法。1992年11月至1998年5月，8例（男∶女 = 4/4，年龄44 - 79岁，平均年龄65.1岁）IMR患者接受了手术修复。术前二尖瓣反流（MR）根据Sellers分类，7例为III级，1例为IV级。MR的病因中，4例为二尖瓣环扩张，2例为乳头肌延长导致的二尖瓣脱垂，2例为部分乳头肌破裂（PMR）。心脏手术中，7例患者行冠状动脉旁路移植术（CABG）+ MVP，1例患者行MVP。二尖瓣修复分为三种类型。针对环扩张的修复，3例患者行交界成形术（2例采用Kay法，1例采用Reed法），1例患者使用Carpentier-Edwards环（C-E环）行环成形术。针对乳头肌延长的修复，包括乳头肌缩短及使用C-E环行环成形术。针对部分PMR的修复，1例患者行乳头肌植入及前叶脱垂环成形术，另1例患者行四边形切除、后叶成形术（McGoon法）及环成形术。无住院死亡病例。术后结果为6例患者无MR，2例患者为II级MR，但通过药物治疗得到良好控制。基于二尖瓣的形态变化，认为IMR的MVP是一种有效且值得推荐的手术方法。
