Beeri Ronen, Streckenbach Scott C, Isselbacher Eric M, Akins Cary W, Vlahakes Gus J, Adams Mark S, Levine Robert A
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
J Am Soc Echocardiogr. 2007 Jun;20(6):698-702. doi: 10.1016/j.echo.2006.11.030.
The need for bileaflet repair in bileaflet mitral valve prolapse (MVP) remains controversial. Will anterior leaflet prolapse resolve with posterior leaflet repair or should both leaflets be addressed? Single-leaflet MVP produces oppositely directed mitral regurgitant jets. Some patients show two crossed jets oppositely directed from the coaptation zone. We hypothesized that these indicate bileaflet lesions requiring complex repair.
Echocardiograms and surgical reports of 52 consecutive patients with MVP undergoing surgery were reviewed.
First, all 14 patients with two oppositely directed jets had prolapse of more than one leaflet. Each jet was related to discrete leaflet distortions causing malcoaptation. Six underwent valve replacement. Seven had both leaflets repaired. One had posterior leaflet repair and annuloplasty, with persistent mitral regurgitation requiring valve replacement. Second, 36 of 38 patients with single jets had single-leaflet MVP. One underwent replacement; all others did well with single-leaflet repair. Two patients with bileaflet MVP but only one jet did well with single-leaflet repair or annuloplasty.
This crossed swords sign is an important clue to bileaflet mechanism of mitral regurgitation in MVP, associated with complex repair procedures. Thus, it provides a clue in the dilemma of bileaflet versus single-leaflet repair.
二尖瓣脱垂（MVP）中双叶修复的必要性仍存在争议。后叶修复后前叶脱垂会缓解吗？还是应该对双叶都进行处理？单叶MVP会产生方向相反的二尖瓣反流束。一些患者显示从瓣叶贴合区发出两个方向相反的交叉反流束。我们推测这些表明需要进行复杂修复的双叶病变。
回顾了52例连续接受手术的MVP患者的超声心动图和手术报告。
首先，所有14例有两个方向相反反流束的患者均有一个以上瓣叶脱垂。每个反流束都与导致瓣叶贴合不良的离散瓣叶变形有关。6例接受了瓣膜置换。7例双叶均进行了修复。1例进行了后叶修复和瓣环成形术，但二尖瓣反流持续存在，需要进行瓣膜置换。其次，38例有单个反流束的患者中有36例为单叶MVP。1例接受了置换；其他所有患者单叶修复效果良好。2例双叶MVP但只有一个反流束的患者单叶修复或瓣环成形术效果良好。
这种“交叉剑征”是MVP中二尖瓣反流双叶机制的重要线索，与复杂的修复手术相关。因此，它为双叶修复与单叶修复的两难困境提供了线索。
