Cohen Laurence, Bennani Raja, Hulin Sylvie, Malergue Marie-Christine, Yemets Ilya, Kalangos Afksendiyos, Murrith Nicolas, Ouaknine Ruth, Lecompte Yves
Institut Cardiologique Paris Sud, Massy, France.
Cardiol Young. 2002 Mar;12(2):138-46. doi: 10.1017/s104795110200029x.
On the basis of our clinical experience, we hypothesized that the role of mitral valvar anomalies in the development and recurrence of discrete subaortic stenosis might be underestimated. From January 1994 to October 2000, the anatomy of the mitral valve and its relationship to the other components of the left ventricular outflow tract were studied by echocardiography in a series of 73 consecutive patients referred to our institution for surgical correction of discrete subaortic stenosis. In all patients for whom it was considered advisable, surgical correction of the mitral anomaly was performed, together with resection of the fibro-muscular subaortic stenosis. One or more mitral valvar anomalies were found in 35 patients (48%). They could be grouped into five categories: insertion of a papillary muscle into the aortic leaflet, insertion of a papillary muscle into the ventricular wall, "muscularization" of the subaortic portion of the aortic leaflet, anomalous insertion of the valvar tissue into the ventricular wall, and accessory valvar tissue. In all cases with anomalous mitral valvar anatomy, surgical correction was feasible. It consisted of transection of the anomalous papillary muscle or its attachment, resection of accessory valvar tissue, and/or patch enlargement of the aortic leaflet. The incidence of mitral valvar anomalies associated with subaortic stenosis is probably underestimated. Our data suggest that they should be systematically searched for during the evaluation of all cases of subaortic stenosis. Their surgical correction is generally feasible, and might improve the mid and long term results.
基于我们的临床经验，我们推测二尖瓣异常在局限性主动脉瓣下狭窄的发生和复发中所起的作用可能被低估了。从1994年1月至2000年10月，我们对连续73例因局限性主动脉瓣下狭窄前来我院接受手术矫正的患者进行了超声心动图检查，以研究二尖瓣的解剖结构及其与左心室流出道其他组成部分的关系。对于所有认为合适的患者，在切除纤维肌性主动脉瓣下狭窄的同时，对二尖瓣异常进行了手术矫正。35例患者（48%）发现有一个或多个二尖瓣异常。它们可分为五类：乳头肌插入主动脉瓣叶、乳头肌插入心室壁、主动脉瓣叶主动脉瓣下部分的“肌化”、瓣膜组织异常插入心室壁以及瓣膜附属组织。在所有二尖瓣解剖结构异常的病例中，手术矫正是可行的。包括切断异常乳头肌或其附着点、切除瓣膜附属组织和/或扩大主动脉瓣叶补片。与主动脉瓣下狭窄相关的二尖瓣异常的发生率可能被低估了。我们的数据表明，在评估所有主动脉瓣下狭窄病例时应系统地寻找这些异常。对其进行手术矫正通常是可行的，并且可能改善中长期结果。
