Acar C, Jebara V A, Grare P, Chachques J C, Dervanian P, Vahanian A, Carpentier A
Service de Chirurgie Cardiothoracique, Hôpital Broussais, Paris, France.
Eur J Cardiothorac Surg. 1992;6(12):660-3; discussion 663-4. doi: 10.1016/1010-7940(92)90191-y.
Percutaneous mitral dilation is a widely accepted technique for treating pure mitral stenosis. Traumatic mitral insufficiency may occur secondary to this technique raising the problem of the feasibility of mitral valve repair. Twenty patients were operated on for traumatic mitral insufficiency following percutaneous mitral dilation. Three patients required emergency operations (within 6 h). In the other cases, surgery was carried out within the following days or weeks. Operative analysis of the mitral valves showed the following lesions: tear of the anterior leaflet (n = 4), tear of the posterior leaflet (n = 2), anterior (n = 4) or posterior (n = 9) paracommissural tear and papillary muscle rupture (n = 1). Associated chordal rupture was found in 3 patients. Septal perforation secondary to transseptal puncture was found in all cases. A septal tear of more than 10 mm was present in 4 patients. Surgery consisted of mitral valve reconstruction (n = 12) or mitral valve replacement (n = 8). Anatomic lesions following percutaneous mitral dilation may affect all the elements of the mitral valve apparatus. The possibility of repair depends more on the degree of calcification of the valve than on the extent of the leaflet tear.
经皮二尖瓣扩张术是治疗单纯二尖瓣狭窄广泛认可的技术。该技术可能继发创伤性二尖瓣关闭不全，引发二尖瓣修复可行性的问题。20例患者在经皮二尖瓣扩张术后因创伤性二尖瓣关闭不全接受手术。3例患者需要急诊手术（6小时内）。其他患者在接下来的数天或数周内接受手术。二尖瓣的手术分析显示如下病变：前叶撕裂（n = 4）、后叶撕裂（n = 2）、前（n = 4）或后（n = 9）交界旁撕裂以及乳头肌破裂（n = 1）。3例患者发现合并腱索断裂。所有病例均发现继发于房间隔穿刺的间隔穿孔。4例患者存在大于10毫米的间隔撕裂。手术包括二尖瓣重建（n = 12）或二尖瓣置换（n = 8）。经皮二尖瓣扩张术后的解剖学病变可能影响二尖瓣装置的所有结构。修复的可能性更多取决于瓣膜的钙化程度而非瓣叶撕裂的范围。
