Erek Ersin, Padala Muralidhar, Pekkan Kerem, Jimenez Jorge, Yalçinba Yusuf K, Salihoğlu Ece, Sarioğlu Tayyar, Yoganathan Ajit P
Department of Cardiovascular Surgery, Acibadem Hospital, Istanbul, Turkey.
J Heart Valve Dis. 2009 May;18(3):300-6.
A new mitral valve repair concept to treat mitral regurgitation (MR) due to valve prolapse was recently proposed. In this study, an improved design of this concept is presented, and the results of preliminary hemodynamic studies conducted in an in-vitro prolapse model are reported.
The new repair approach is based on using a web/net attached to a standard annuloplasty ring spanning the annulus of the mitral valve. Experiments were conducted in a left ventricular simulator, using native porcine mitral valves. Severe MR was created by transecting the marginal chordae to induce P2 prolapse, and also by displacing the papillary muscles basally to induce bileaflet prolapse.
Implantation of the mitral web prevented leaflet prolapse and restored leaflet coaptation with trace mitral insufficiency, in both posterior and bileaflet prolapse. In posterior leaflet prolapse, implantation of the mitral web reduced the regurgitation volume from 10.43 +/- 3.76 ml to 2.13 +/- 1.83 ml per beat (p < 0.05). No visual damage was observed on the mitral valve leaflets after 4 h of continuous operation.
Based on the study results, the mitral web may represent a feasible option to repair different types of mitral valve prolapse. The mitral web may also significantly simplify mitral valve repair for complex lesions.
最近提出了一种治疗因瓣膜脱垂导致二尖瓣反流（MR）的新二尖瓣修复概念。在本研究中，展示了该概念的一种改进设计，并报告了在体外脱垂模型中进行的初步血流动力学研究结果。
新的修复方法基于使用附着在跨越二尖瓣瓣环的标准瓣环成形环上的网/网片。使用天然猪二尖瓣在左心室模拟器中进行实验。通过横断边缘腱索诱导P2脱垂以及通过将乳头肌向基部移位诱导双叶脱垂来产生严重的MR。
二尖瓣网的植入可防止瓣叶脱垂，并在后部和双叶脱垂中恢复瓣叶贴合，二尖瓣反流微量。在后部瓣叶脱垂中，二尖瓣网的植入使每搏反流容积从10.43±3.76 ml减少至2.13±1.83 ml（p<0.05）。连续运行4小时后，二尖瓣瓣叶未观察到可见损伤。
基于研究结果，二尖瓣网可能是修复不同类型二尖瓣脱垂的一种可行选择。二尖瓣网还可能显著简化复杂病变的二尖瓣修复。
