Mills William R, Barber J Edward, Ratliff Norman B, Cosgrove Delos M, Vesely Ivan, Griffin Brian P
Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Am Heart J. 2004 Jul;148(1):144-50. doi: 10.1016/j.ahj.2004.01.021.
Flail mitral leaflet (FML) is a common complication of mitral valve prolapse, often leading to severe mitral regurgitation (MR) and left ventricular dysfunction. In the absence of timely surgical correction, survival is significantly impaired. Early recognition of FML and identification of risk factors is important because early intervention increases the chances of survival.
We studied 123 patients undergoing mitral valve surgery for severe MR caused by myxomatous disease. Chart review, echocardiography, and tensile testing were performed.
Thirty-eight patients had FML, and 85 patients had non-flail mitral leaflet (non-FML). Patients with FML were younger (53.7 +/- 1.8 vs 59.3 +/- 1.4 years, P =.02), had more severe MR (3.89 +/- 0.04 vs 3.76 +/- 0.04, P =.02), were less likely to be in New York Heart Association class III or IV heart failure (5% vs 20%, P =.037), and were less likely to have bileaflet mitral valve prolapse (5% vs 38%, P <.001) than non-FML patients. Valve tissue from patients with FML had less stiff chordae (23.5 +/- 3.6 vs 59.1 +/- 11.7 Mpa, P =.006) that tended to have a lower failure stress (3.8 +/- 0.9 vs 9.6 +/- 2.2 Mpa, P =.07) and had more extensible leaflets (56.4% +/- 7.9% vs 42.9% +/- 2.7% strain, P =.04) compared with that of non-FML patients.
The development of FML may result from intrinsic tissue abnormalities and is associated with a distinct subset of the myxomatous population. Identification of such clinical characteristics in this population and knowledge of an implicit mechanical abnormality of valve tissue may further the argument for early surgical correction.
连枷样二尖瓣叶（FML）是二尖瓣脱垂的常见并发症，常导致严重二尖瓣反流（MR）和左心室功能障碍。若不及时进行手术矫正，生存率将显著受损。早期识别FML并确定危险因素很重要，因为早期干预可增加生存机会。
我们研究了123例因黏液瘤病导致严重MR而接受二尖瓣手术的患者。进行了病历审查、超声心动图检查和拉伸试验。
38例患者有FML，85例患者有非连枷样二尖瓣叶（非FML）。与非FML患者相比，FML患者更年轻（53.7±1.8岁对59.3±1.4岁，P = 0.02），MR更严重（3.89±0.04对3.76±0.04，P = 0.02），纽约心脏协会III或IV级心力衰竭的可能性更小（5%对20%，P = 0.037），双叶二尖瓣脱垂的可能性更小（5%对38%，P < 0.001）。与非FML患者相比，FML患者的瓣膜组织腱索硬度更低（23.5±3.6对59.1±11.7 Mpa，P = 0.006），断裂应力倾向于更低（3.8±0.9对9.6±2.2 Mpa，P = 0.07），瓣叶更具延展性（56.4%±7.9%对42.9%±2.7%应变，P = 0.04）。
FML的发生可能源于内在组织异常，并与黏液瘤病患者的一个独特亚组相关。识别该人群中的此类临床特征以及了解瓣膜组织潜在的机械异常可能会进一步支持早期手术矫正的观点。
