Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Japan.
Circ J. 2009 Nov;73(11):2061-7. doi: 10.1253/circj.cj-09-0129. Epub 2009 Sep 10.
Papillary muscle (PM) suspension concomitant with mitral annuloplasty and PM approximation (PMA) has been developed for functional mitral regurgitation (MR). In the present study, the early effect of PM suspension (PMS) on the postoperative mitral geometry and diastolic mitral tethering was investigated.
Subjects were 22 patients with left ventricular dysfunction and functional MR who underwent mitral annuloplasty and PMA with or without suspension from 2004 to 2008. The purpose of PMS is to maintain the mitral complex geometry and prevent future mitral tethering caused by left ventricular remodeling. The mean age was 64 +/-10 (range 39-85) years. The submitral apparatus geometry was measured by echocardiography. PM and mitral inflow angles in the anterior-directional suspension group were significantly larger than those in the posterior-directional suspension group (57 +/-7 degrees vs 46 +/-9 degrees , P=0.017 and 78 +/-9 degrees vs 60 +/-6 degrees , P<0.001, respectively), which were comparable to the normal control. In the posterior-directional suspension group, the transmitral pressure gradient was higher and restrictive mitral filling pattern remained postoperatively in 2 cases of the group.
Anterior-directional suspension is preferable to the posterior one in terms of diastolic mitral filling.
乳头肌（PM）悬吊术联合二尖瓣环成形术和 PM 接近术（PMA）已被开发用于治疗功能性二尖瓣反流（MR）。本研究旨在探讨 PM 悬吊术（PMS）对术后二尖瓣几何形状和舒张期二尖瓣牵张的早期影响。
本研究共纳入 2004 年至 2008 年间因左心室功能障碍和功能性 MR 接受二尖瓣环成形术和 PMA 联合或不联合 PM 悬吊术的 22 例患者。PMS 的目的是维持二尖瓣复合体的几何形状，防止左心室重构引起的未来二尖瓣牵张。通过超声心动图测量瓣下装置的几何形状。在前向悬吊组中，PM 和二尖瓣前向血流角度显著大于后向悬吊组（57±7°比 46±9°，P=0.017；78±9°比 60±6°，P<0.001），与正常对照组相似。在后向悬吊组中，有 2 例术后跨瓣压力梯度较高，限制性二尖瓣充盈模式仍然存在。
在舒张期二尖瓣充盈方面，前向悬吊优于后向悬吊。
