Morimoto Hironobu, Tsuchiya Koji, Nakajima Masato, Akashi Okihiko
Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan.
J Card Surg. 2008 Sep-Oct;23(5):426-30. doi: 10.1111/j.1540-8191.2008.00627.x. Epub 2008 Jun 18.
Mitral valve repair is now the surgical treatment of choice for mitral regurgitation. However, the repair of anterior leaflet prolapse due to chordal rupture or elongation remains a technically challenging procedure. Here, we review our experience and present the long-term results of mitral valve repair for mitral regurgitation due to anterior leaflet prolapse.
Between January 1988 and August 2006, 210 patients with mitral regurgitation underwent mitral valve reconstruction. We performed mitral valve repair in 49 patients with mitral regurgitation due to anterior leaflet prolapse. The preoperative degree of mitral regurgitation was moderate to severe in all patients. There were 36 patients (73.5%) with degenerative, eight (16.3%) with infective endocarditis, and five (10.2%) with rheumatic. Reconstructive techniques included chordal replacement in 13 patients, chordal shortening in 14, chordal transposition in five, chordal shortening and reinforcement with artificial chordae in four, leaflet folding plasty in six, and resection-suture in four.
Follow-up was complete with an average of 89 +/- 59 months (range 1-201 months). In the early postoperative period, transthoracic echocardiography was performed in all patients. The grade of regurgitation was trivial (Grade I) in 17 patients (34.7%) and mild (Grade II) in seven patients (14.3%). Survival rate at 10 and 15 years was 95.2% and 88.9%, respectively. Freedom from reoperation at 10 and 15 years was 95.8% and 89.0%, respectively.
The long-term results of mitral valve repair for anterior leaflet prolapse are satisfactory, with low mortality and morbidity. In particular, chordal replacement using temporary Alfieri stitch is a simple and effective procedure.
二尖瓣修复术目前是二尖瓣反流的外科治疗选择。然而，因腱索断裂或延长导致的前叶脱垂修复仍是一项技术上具有挑战性的手术。在此，我们回顾我们的经验并呈现因前叶脱垂导致二尖瓣反流的二尖瓣修复术的长期结果。
在1988年1月至2006年8月期间，210例二尖瓣反流患者接受了二尖瓣重建术。我们对49例因前叶脱垂导致二尖瓣反流的患者进行了二尖瓣修复术。所有患者术前二尖瓣反流程度为中至重度。其中36例（73.5%）为退行性病变，8例（16.3%）为感染性心内膜炎，5例（10.2%）为风湿性病变。重建技术包括13例患者的腱索置换、14例的腱索缩短、5例的腱索移位、4例的腱索缩短及用人造腱索加强、6例的瓣叶折叠成形术和4例的切除 - 缝合术。
随访完整，平均随访时间为89±59个月（范围1 - 201个月）。术后早期，所有患者均接受经胸超声心动图检查。17例患者（34.7%）反流程度为微量（I级），7例患者（14.3%）为轻度（II级）。10年和15年生存率分别为95.2%和88.9%。10年和15年免于再次手术率分别为95.8%和89.0%。
前叶脱垂二尖瓣修复术的长期结果令人满意，死亡率和发病率较低。特别是，使用临时阿尔菲里缝合进行腱索置换是一种简单有效的手术。
