Ng C K, Punzengruber C, Pachinger O, Nesser J, Auer H, Franke H, Hartl P
Department of Cardiovascular Surgery and Cardiology, General Hospital Wels, Austria.
Ann Thorac Surg. 2000 Jul;70(1):53-8. doi: 10.1016/s0003-4975(00)01347-3.
Valvuloplasty has significant advantages over valve replacement for mitral regurgitation, but the presence of severe calcification of the mitral valve apparatus has been thought to preclude successful valve reconstruction in general. The purpose of this report is to assess the results of valvuloplasty in patients with severe mitral regurgitation having extensive calcification extending from the mitral annulus to underlying myocardium and parts of the papillary muscles.
Thirty-seven adult patients with severe mitral regurgitation and calcification were operated on between April 1990 and January 1998. Twenty-six patients had degenerative disease, 4 had acute bacterial endocarditis, 6 had postrheumatic fever, and 1 patient had Marfan's disease. The valve repair comprised of en bloc decalcification with extensive leaflet debridement and reconstruction of the annulus. Autologous pericardium was used in patch-extended endocardial annuloplasty or leaflet repair. Valve competence was retained after correction of regurgitation by sliding atrioplasty, rotation paracommissural sliding plasty, cusp remodeling, or chordal repair. All patients required a prosthetic annuloplasty.
Follow-up echocardiography at 47 months (range, 3 to 92 months) showed no or only trivial mitral regurgitation in 33 patients; 3 had grade I-II mitral regurgitation and 1 required valve replacement after 3 months. Freedom of reoperation at 1 and 5 years was 94.6%. At last examination, 33 patients were in New York Heart Association functional class I and 3 in class I-II; there has been no mortality and no thromboembolic events.
Valvuloplasty can be safely and successfully carried out in patients suffering from regurgitation associated with severe calcification of the mitral apparatus. With encouraging beneficial midterm results, we suggest patients with calcified valves should not be excluded from mitral repair.
对于二尖瓣反流，瓣膜成形术相对于瓣膜置换术具有显著优势，但一般认为二尖瓣装置严重钙化会妨碍成功的瓣膜重建。本报告的目的是评估二尖瓣反流且伴有从二尖瓣环延伸至心肌下层和部分乳头肌的广泛钙化的患者行瓣膜成形术的结果。
1990年4月至1998年1月期间，对37例患有严重二尖瓣反流和钙化的成年患者进行了手术。26例患者患有退行性疾病，4例患有急性细菌性心内膜炎，6例患有风湿热后疾病，1例患有马凡氏综合征。瓣膜修复包括整块脱钙、广泛的瓣叶清创和瓣环重建。自体心包用于补片扩展的心内膜瓣环成形术或瓣叶修复。通过滑动心房成形术、旋转旁联合滑动成形术、瓣尖重塑或腱索修复纠正反流后，保留了瓣膜功能。所有患者均需要进行人工瓣环成形术。
47个月（范围3至92个月）的随访超声心动图显示，33例患者无或仅有轻微二尖瓣反流；3例有I-II级二尖瓣反流，1例在3个月后需要进行瓣膜置换。1年和5年再次手术的自由度为94.6%。在最后一次检查时，33例患者处于纽约心脏协会功能I级，3例处于I-II级；无死亡病例，也无血栓栓塞事件。
对于患有与二尖瓣装置严重钙化相关反流的患者，瓣膜成形术可以安全、成功地进行。鉴于中期结果令人鼓舞，我们建议不应将钙化瓣膜患者排除在二尖瓣修复之外。
