Luo Xiao-Liang, Qiao Shu-Bin, Yuan Jian-Song, Guan Ting, Chen Jue, Chen Ji-Lin, Song Lai-Feng, Gao Run-Lin
Coronary Heart Disease Center, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Mar;37(3):253-6.
To analyze the clinical, echocardiographic features and therapy efficacy of patients with ruptured mitral chordae tendineae.
Clinical data, echocardiographic and pathological results from 292 hospitalized patients with ruptured mitral chordae tendineae were retrospectively analyzed.
There were 99 cases (33.9%) with rupture of anterior leaflet and 180 cases (61.6%) with rupture of posterior leaflet, 13 cases (4.5%) with both anterior and posterior leaflet ruptures. Partial rupture of mitral chordae tendineae was found in 266 cases (91.1%) and total rupture in 26 cases (8.9%). Two hundred and fourteen cases (73.3%) were primary chordal rupture and 78 (26.7%) were secondary chordal rupture (P < 0.05). Primary chordal rupture was mostly due to mucus degeneration of the mitral valve, mostly presented as posterior leaflet rupture in aged male patients. Secondary chordal rupture was mostly caused by infective endocarditis, coronary heart disease, congenital heart disease and rheumatic heart diseases. Patients with secondary chordal rupture cases were significantly younger than patients with primary chordal rupture and there were significantly more anterior leaflet rupture than posterior leaflet rupture. One hundred and thirty patients received mitral valve reconstruction operation and another 110 underwent mitral valve replacement therapy and discharged complication free. The remaining 52 cases received medication therapy and discharged with improved symptoms (12 with mild chordal rupture without operation indication, 17 cases contraindicated to operative therapy, 7 cases transferred to other hospitals and 16 patients refused operation therapy).
The incidence of posterior leaflet rupture is higher than that of anterior leaflet rupture. Rupture of both anterior and posterior leaflet is rare and there are more primary chordal ruptures than secondary chordal ruptures based on our patient cohort. Mitral valve reconstruction operation and mitral valve replacement therapy are effective operative therapy options for the treatment of mitral chordal ruptures in indicated patients.
分析二尖瓣腱索断裂患者的临床、超声心动图特征及治疗效果。
回顾性分析292例住院的二尖瓣腱索断裂患者的临床资料、超声心动图及病理结果。
前叶断裂99例（33.9%），后叶断裂180例（61.6%），前后叶均断裂13例（4.5%）。二尖瓣腱索部分断裂266例（91.1%），完全断裂26例（8.9%）。原发性腱索断裂214例（73.3%），继发性腱索断裂78例（26.7%）（P<0.05）。原发性腱索断裂主要因二尖瓣黏液样变性，多见于老年男性患者，以后叶断裂为主。继发性腱索断裂主要由感染性心内膜炎、冠心病、先天性心脏病及风湿性心脏病引起。继发性腱索断裂患者明显较原发性腱索断裂患者年轻，且前叶断裂明显多于后叶断裂。130例患者接受二尖瓣重建手术，110例接受二尖瓣置换治疗，均无并发症出院。其余52例接受药物治疗，症状改善后出院（12例轻度腱索断裂无手术指征，17例手术治疗禁忌，7例转至其他医院，16例拒绝手术治疗）。
后叶断裂发生率高于前叶断裂。根据我们的患者队列，前后叶均断裂少见，原发性腱索断裂多于继发性腱索断裂。二尖瓣重建手术和二尖瓣置换治疗是治疗二尖瓣腱索断裂的有效手术治疗选择。
