Cho L, Gillinov A M, Cosgrove D M, Griffin B P, Garcia M J
Cleveland Clinic Foundation, Ohio, USA.
Am J Cardiol. 2000 Dec 15;86(12):1349-51. doi: 10.1016/s0002-9149(00)01240-6.
Recent data suggest that posterior leaflet repair alone corrects mitral regurgitation in patients with bileaflet prolapse and normal anterior chordae. The purpose of this study was to use echocardiography to define the anatomic differences between posterior and bileaflet prolapse and to determine if posterior leaflet repair alone leads to correction of bileaflet prolapse. We studied patients who underwent quadrangular resection of the posterior mitral valve leaflet to treat bileaflet prolapse (group I, n = 20) or isolated posterior leaflet prolapse (group II, n = 20). Echocardiographic characteristics were compared before and after the procedure. There were no differences in the left ventricular end-diastolic or end-systolic dimensions or function between the 2 groups. However, anterior leaflet length was greater in patients with bileaflet prolapse (3.3 +/- 0.6 cm vs 2.6 +/- 0.4 cm, p = 0.003). In group I, posterior leaflet repair changed anterior leaflet displacement from -0.8 +/- 0.2 to 0.5 +/- 0.4 cm (p <0.001) and posterior leaflet displacement from -0.8 +/- 0.3 cm below to 0.5 +/- 0.4 cm (p <0.001) in front of the mitral annular plane. In group II, anterior leaflet displacement was unchanged from 0.2 +/- 0.1 to 0.3 +/- 0.2 cm (p = 0.22), whereas posterior leaflet displacement changed from -0.7 +/- 0.2 to 0.4 +/- 0.2 cm (p <0.001). Thus, patients with bileaflet prolapse and no ruptured chords have excessive anterior leaflet length. In such patients, posterior leaflet repair alone corrects anterior and posterior leaflet prolapse.
近期数据表明，对于双叶瓣脱垂且前叶腱索正常的患者，单纯后叶修复可纠正二尖瓣反流。本研究的目的是利用超声心动图确定后叶脱垂与双叶瓣脱垂之间的解剖学差异，并确定单纯后叶修复是否能纠正双叶瓣脱垂。我们研究了接受二尖瓣后叶四边形切除术以治疗双叶瓣脱垂的患者（I组，n = 20）或单纯后叶脱垂的患者（II组，n = 20）。对手术前后的超声心动图特征进行了比较。两组之间左心室舒张末期或收缩末期尺寸及功能无差异。然而，双叶瓣脱垂患者的前叶长度更长（3.3±0.6 cm对2.6±0.4 cm，p = 0.003）。在I组中，后叶修复使二尖瓣环平面之前的前叶移位从-0.8±0.2变为0.5±0.4 cm（p<0.001），后叶移位从二尖瓣环平面以下-0.8±0.3 cm变为0.5±0.4 cm（p<0.001）。在II组中，前叶移位从0.2±0.1变为0.3±0.2 cm无变化（p = 0.22），而后叶移位从-0.7±0.2变为0.4±0.2 cm（p<0.001）。因此，双叶瓣脱垂且腱索未断裂的患者前叶长度过长。在此类患者中，单纯后叶修复可纠正前叶和后叶脱垂。
