Cook Richard C, Nifong L Wiley, Lashley Graham G, Duncan Robert A, Campbell Julie A, Law Y Brandon, Chitwood W Randolph
University of British Columbia, Vancouver, British Columbia, Canada.
J Heart Valve Dis. 2006 Jul;15(4):524-7; discussion 527.
Successful mitral valve repair (MVP) is dependent on accurate annuloplasty band sizing. This is difficult and time-consuming when performed via port-access, or through a 4-cm minithoracotomy used in robotically assisted MVP. With the goal of moving toward a less-invasive approach and minimizing cross-clamp time, an attempt was made to determine annuloplasty band size using transesophageal echocardiography (TEE) alone.
The intertrigonal distance (ITD) was determined by dividing the left ventricular outflow tract diameter (LVOT: measured on standard midesophageal aortic valve long-axis view) by 0.8. The ITD was compared to a nomogram developed to select the best Cosgrove-Edwards annuloplasty band size.
Between July and October, 2004, 11 patients (mean age 52.6 +/- 17.9 years; four Barlow's valves with bileaflet prolapse, four posterior leaflet prolapses, one anterior leaflet prolapse, one rheumatic, one dilated annulus) undergoing robotically assisted MVP had the annuloplasty band chosen using TEE alone. Seven patients (63.6%) had no or mild mitral regurgitation (MR) on postoperative TEE. Three patients (27.2%) had some systolic anterior motion (SAM), with one (Barlow's valve) requiring a second repair (same operation). One patient (9.1%, rheumatic) had grade 2+ MR on postoperative TEE.
In this small case series, a substantial proportion of patients had suboptimal immediate postoperative results. This suggests that selection of the annuloplasty band should not be based on a single echocardiographic variable as it depends on the etiology of the MR, and other dimensions of the mitral valve. Further studies are ongoing to develop a non-invasive method for the selection of annuloplasty band size.
二尖瓣修复术（MVP）的成功取决于准确的瓣环成形带尺寸确定。通过端口入路或在机器人辅助MVP中使用的4厘米小切口开胸手术进行时，这一操作困难且耗时。为了朝着微创方法发展并尽量缩短主动脉阻断时间，尝试单独使用经食管超声心动图（TEE）来确定瓣环成形带尺寸。
通过将左心室流出道直径（LVOT：在标准食管中段主动脉瓣长轴视图上测量）除以0.8来确定三角间距离（ITD）。将ITD与为选择最佳Cosgrove-Edwards瓣环成形带尺寸而制定的列线图进行比较。
在2004年7月至10月期间，11例接受机器人辅助MVP的患者（平均年龄52.6±17.9岁；4例Barlow瓣伴双叶脱垂，4例后叶脱垂，1例前叶脱垂，1例风湿性，1例瓣环扩张）仅使用TEE选择瓣环成形带。7例患者（63.6%）术后TEE显示无或轻度二尖瓣反流（MR）。3例患者（27.2%）有一些收缩期前向运动（SAM），其中1例（Barlow瓣）需要再次修复（同一次手术）。1例患者（9.1%，风湿性）术后TEE显示有2+级MR。
在这个小病例系列中，相当一部分患者术后即刻结果不理想。这表明瓣环成形带的选择不应基于单一的超声心动图变量，因为它取决于MR的病因以及二尖瓣的其他尺寸。正在进行进一步研究以开发一种无创方法来选择瓣环成形带尺寸。
