Sakai K, Nakano S, Taniguchi K, Sakaki S, Hirata N, Shintani H, Shimazaki Y, Kawashima Y, Matsuda H
Division of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
Circulation. 1992 Nov;86(5 Suppl):II39-45.
In surgery for chronic mitral regurgitation, the mitral subvalvular apparatus, including annulus, may play an important role in preserving left ventricular (LV) performance. The suture annuloplasty for mitral regurgitation allows annular contraction of the mitral valve. The potential effects of suture annuloplasty on the postoperative LV performance have not been fully defined.
Global and regional LV function in 12 patients with suture annuloplasty were compared with 12 patients with conventional mitral valve replacement (MVR). Cineangiography and echocardiography were obtained before and 10.8 months after surgery. End-diastolic volume index and end-systolic volume index decreased significantly in both groups after surgery (p < 0.01). Ejection fraction remained unchanged in the suture annuloplasty group, whereas it decreased significantly in the MVR group after surgery (p < 0.01). There was a significant inverse relation between ejection fraction and end-systolic wall stress in the two groups after surgery (suture annuloplasty group, r = -0.69, p = 0.01; MVR group, r = -0.60, p = 0.04). The intercept on the y axis was significantly (p < 0.005) higher in the suture annuloplasty group than in the MVR group. In the suture annuloplasty group, cross-sectional area ejection fraction at the mitral valve level and at the papillary muscle level by LV two-dimensional echocardiography remained unchanged after surgery. In the MVR group, they decreased significantly after surgery (p < 0.01). There was a significant correlation between the cross-sectional area ejection fraction and the global ejection fraction at both levels after surgery. Therefore, the improvement of the regional wall motion can be attributed to the improvement of the global LV performance after suture annuloplasty.
These data suggest that suture annuloplasty can provide more desirable postoperative LV systolic performance than conventional MVR by preserving both the contraction of the mitral annulus and the mitral valvular-ventricular interaction.
在慢性二尖瓣反流手术中，二尖瓣瓣下结构，包括瓣环，可能在维持左心室（LV）功能方面发挥重要作用。二尖瓣反流的缝线瓣环成形术可使二尖瓣瓣环收缩。缝线瓣环成形术对术后左心室功能的潜在影响尚未完全明确。
将12例行缝线瓣环成形术的患者与12例行传统二尖瓣置换术（MVR）的患者的整体和局部左心室功能进行比较。在手术前及术后10.8个月进行心血管造影和超声心动图检查。两组患者术后舒张末期容积指数和收缩末期容积指数均显著降低（p<0.01）。缝线瓣环成形术组射血分数保持不变，而MVR组术后射血分数显著降低（p<0.01）。两组患者术后射血分数与收缩末期壁应力之间存在显著负相关（缝线瓣环成形术组，r = -0.69，p = 0.01；MVR组，r = -0.60，p = 0.04）。缝线瓣环成形术组y轴截距显著高于MVR组（p<0.005）。在缝线瓣环成形术组，左心室二维超声心动图显示二尖瓣水平和乳头肌水平的横截面积射血分数术后保持不变。在MVR组，术后显著降低（p<0.01）。术后两个水平的横截面积射血分数与整体射血分数之间存在显著相关性。因此，缝线瓣环成形术后局部壁运动的改善可归因于整体左心室功能的改善。
这些数据表明，缝线瓣环成形术通过保留二尖瓣瓣环收缩和二尖瓣-心室相互作用，可提供比传统MVR更理想的术后左心室收缩功能。
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