Tibayan Frederick A, Rodriguez Filiberto, Liang David, Daughters George T, Ingels Neil B, Miller D Craig
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305-5247, USA.
Circulation. 2003 Sep 9;108 Suppl 1:II128-33. doi: 10.1161/01.cir.0000087942.09226.b2.
Ring annuloplasty, the standard treatment for ischemic mitral regurgitation (IMR), abolishes normal annular dynamics and freezes the posterior leaflet. We examined the impact of Paneth suture annuloplasty during acute IMR on motion of the mitral annulus and leaflets in an ovine model.
Eight sheep had radiopaque markers placed on the left ventricle, anterior mitral leaflet, posterior mitral leaflet, and mitral annulus. A Paneth suture annuloplasty that could be reversibly tightened was anchored to each fibrous trigone and externalized through the mid-lateral mitral annulus. Acute IMR was induced by proximal circumflex artery occlusion. Transesophageal echocardiography assessed the degree of IMR, and biplane cinefluoroscopy measured 3-dimensional marker coordinates before and during circumflex ischemia, and tightening of the Paneth suture. Paneth suture annuloplasty eliminated acute IMR, and reduced septal-lateral and commissure-commissure mitral annular dimensions. Tightening of the annuloplasty sutures, even beyond the degree necessary to eliminate mitral regurgitation (MR), did not reduce septal-lateral or commissure-commissure annular shortening, shortening of the muscular annular perimeter, annular flexion, or angular excursion of the anterior or posterior leaflets relative to ischemic conditions.
In contrast to ring annuloplasty, annular reduction sufficient to restore mitral competence during acute IMR can be achieved with a Paneth suture annuloplasty while simultaneously maintaining normal annular and leaflet dynamic motion. These findings should prompt additional investigation and design of repair methods that preserve the mobility of the mitral apparatus.
环缩成形术是缺血性二尖瓣反流（IMR）的标准治疗方法，它消除了正常的瓣环动力学并固定了后叶。我们在绵羊模型中研究了急性IMR期间潘氏缝线环缩成形术对二尖瓣瓣环和瓣叶运动的影响。
八只绵羊在左心室、二尖瓣前叶、二尖瓣后叶和二尖瓣瓣环上放置了不透射线的标记物。一种可可逆收紧的潘氏缝线环缩成形术被固定在每个纤维三角区，并通过二尖瓣环中外侧引出。通过近端回旋支动脉闭塞诱导急性IMR。经食管超声心动图评估IMR的程度，双平面电影荧光透视法测量在回旋支缺血期间及潘氏缝线收紧前后三维标记物的坐标。潘氏缝线环缩成形术消除了急性IMR，并减小了二尖瓣瓣环的室间隔-侧壁及瓣环连合-连合尺寸。即使在超过消除二尖瓣反流（MR）所需程度的情况下收紧环缩成形术缝线，相对于缺血状态，也不会减少室间隔-侧壁或瓣环连合-连合的瓣环缩短、肌性瓣环周长的缩短、瓣环弯曲或前叶或后叶的角度偏移。
与环缩成形术不同，潘氏缝线环缩成形术在急性IMR期间可实现足以恢复二尖瓣功能的瓣环缩小，同时保持正常的瓣环和瓣叶动态运动。这些发现应促使对保留二尖瓣装置活动度的修复方法进行更多的研究和设计。
