用于缺血性二尖瓣反流的原乳头肌三明治成形术。

Original papillary muscle sandwich plasty for ischemic mitral regurgitation.

作者信息

Ishikawa Susumu, Ueda Keisuke, Kawasaki Akio, Neya Kazuo, Abe Keiko, Suzuki Haruo, Kugawa Satoshi

机构信息

Cardiovascular Division, Department of Surgery, Teikyo University School of Medicine, Kaga, Tokyo, Japan.

出版信息

Circ J. 2009 Jul;73(7):1240-2. doi: 10.1253/circj.cj-08-0585. Epub 2009 May 18.

DOI:10.1253/circj.cj-08-0585

PMID:19448328

Abstract

BACKGROUND

Mitral valve plasty for functional ischemic mitral regurgitation (MR) is still a controversial procedure.

METHODS AND RESULTS

The present study was a review of 23 patients who underwent an original technique known as "papillary muscle sandwich plasty" in which the mitral valve is approached via either the left atrium or left ventricle. The heads of the papillary muscles of the anterior leaflet and leaflets are plicated using Teflon-pledgeted 3-0 Ticron sutures in both the anterolateral and posteromedial commissural portions. Postoperative residual mild MR occurred in 1 patient (4%), but moderate or severe MR was not observed. In the follow-up study, prominent MR occurred in 1 patients and the MR-free rate at 2 years after surgery was 93%. Late cardiac death was significantly (P<0.05) fewer in patients without prominent MR than that in patients with MR.

CONCLUSIONS

"Sandwich plasty" is an effective technique for patients requiring left ventricular plasty and may improve the prognosis of ischemic heart failure.

摘要

背景

功能性缺血性二尖瓣反流（MR）的二尖瓣成形术仍是一种有争议的手术。

方法与结果

本研究回顾了23例接受一种称为“乳头肌夹层成形术”的原始技术的患者，该技术通过左心房或左心室入路处理二尖瓣。在前外侧和后内侧连合部，使用带聚四氟乙烯垫片的3-0涤纶缝线将前叶和小叶的乳头肌头部折叠。1例患者（4%）术后出现轻度残余MR，但未观察到中度或重度MR。在随访研究中，1例患者出现明显MR，术后2年无MR发生率为93%。无明显MR的患者晚期心源性死亡显著（P<0.05）少于有MR的患者。