Salati M, Scrofani R, Fundaró P, Cialfi A, Santoli C
Department of Thoracic and Cardiovascular Surgery, Luigi Sacco Hospital, Milan, Italy.
J Thorac Cardiovasc Surg. 1992 Nov;104(5):1268-73.
From 1986 to 1992 102 mitral valve repairs were done for mitral regurgitation due to a degenerative disease. Forty-eight patients had an anterior prolapse or prolapse of both leaflets at initial presentation and underwent chordal transposition from the mural leaflet to the anterior leaflet. The corrective procedure was completed by polytetrafluoroethylene or pericardial posterior annuloplasty. Operative mortality was 2.9%, and follow-up (average 22 months) was 100% complete. There were three postreconstruction valve replacements (one earlier and two later) for a probability of freedom from reoperation of 91.5% +/- 5.2% at 3 years. Freedom from all morbidity was 85.5% +/- 5.5% at 3 years. Postoperative echocardiographic studies demonstrated a good mitral valve function: (1) Eighty-seven percent of patients presented no or mild residual regurgitation; (2) transmitral flow indexes were within the norm; (3) left ventricular outflow tract flow was normal in all patients. This study shows that chordal transposition is a safe and effective technique for prolapse of anterior or both leaflets and improves the chances of repair in patients with mitral degenerative disease.
1986年至1992年期间，对102例因退行性疾病导致二尖瓣反流的患者进行了二尖瓣修复手术。48例患者初次就诊时存在前叶脱垂或双叶脱垂，接受了腱索从壁叶转移至前叶的手术。通过聚四氟乙烯或心包后瓣环成形术完成矫正手术。手术死亡率为2.9%，随访（平均22个月）完成率为100%。有3例重建后进行了瓣膜置换（1例较早，2例较晚），3年时再次手术的无事件生存率为91.5%±5.2%。3年时无所有并发症的发生率为85.5%±5.5%。术后超声心动图研究显示二尖瓣功能良好：（1）87%的患者无残余反流或仅有轻度残余反流；（2）跨二尖瓣血流指数在正常范围内；（3）所有患者左心室流出道血流均正常。本研究表明，腱索转移术对于前叶或双叶脱垂是一种安全有效的技术，可提高二尖瓣退行性疾病患者的修复成功率。
