Collison Sathiakar Paul, Kaushal Sunil Kumar, Dagar Kulbushan Singh, Iyer Parvathi Unninayar, Girotra Sumir, Radhakrishnan Sitaraman, Shrivastava Savitri, Iyer Krishna Subramony
Escorts Heart Institute and Research Centre, New Delhi, India.
Ann Thorac Surg. 2006 Mar;81(3):997-1001. doi: 10.1016/j.athoracsur.2005.06.079.
Management of congenital stenotic mitral valvular abnormalities remains an important therapeutic challenge. Supramitral ring constitutes a small but inadequately described subset that has a relatively good outcome with appropriate management.
Between 1996 and 2004, 15 patients with supramitral ring were managed in this institution. The demographic and clinical features, diagnostic modalities, morphology of the rings, and the surgical management were studied retrospectively.
Accurate preoperative diagnosis was possible by transthoracic echocardiography in 11 patients (73%). The associated anomalies were ventricular septal defects in 8 patients (53%) and abnormalities of the left ventricular outflow tract in 7 patients (47%). A circumferential supramitral ring, separate from the mitral valve, was present in 8 patients (53%). In the remaining, the ring was attached circumferentially to the anterior and the posterior mitral leaflets and was most densely adherent at the posteroinferior commissure in 4 of these 7 patients (57%). Complete excision of ring was possible in all cases, without damage to the mitral valve. There was 1 in-hospital death (6%). At a mean follow-up of 30 months, 14 survivors continue to do well, with no significant recurrence of mitral stenosis.
Patients with supramitral ring constitute a subset of patients with congenital mitral stenosis who have a relatively good prognosis. In many cases, the supramitral ring is entirely separate from the mitral valve, and when attached, it is usually most prominent at the posteroinferior commissure. In both cases, complete resection is surgically feasible and usually provides lasting relief.
先天性二尖瓣狭窄异常的治疗仍然是一项重要的治疗挑战。二尖瓣上环形结构是一个较小但描述不充分的亚组，通过适当的管理，其预后相对较好。
1996年至2004年期间，本机构对15例二尖瓣上环形结构患者进行了治疗。回顾性研究了患者的人口统计学和临床特征、诊断方式、环形结构的形态以及手术治疗情况。
11例患者（73%）通过经胸超声心动图能够进行准确的术前诊断。相关异常包括8例（53%）室间隔缺损和7例（47%）左心室流出道异常。8例患者（53%）存在与二尖瓣分离的环形二尖瓣上结构。其余患者中，环形结构沿圆周附着于二尖瓣前后叶，在这7例患者中的4例（57%）中，环形结构在二尖瓣后下联合处附着最紧密。所有病例均可行环形结构完全切除，且未损伤二尖瓣。有1例住院死亡（6%）。平均随访30个月时，14例幸存者情况良好，二尖瓣狭窄无明显复发。
二尖瓣上环形结构患者是先天性二尖瓣狭窄患者中预后相对较好的一个亚组。在许多情况下，二尖瓣上环形结构与二尖瓣完全分离，若附着，则通常在二尖瓣后下联合处最为明显。在这两种情况下，手术完全切除都是可行的，并且通常能提供持久的缓解。
