Ishikawa Susumu, Kugawa Satoshi, Abe Keiko, Neya Kazuo, Shirato Hiroyuki, Jojima Kumiko, Horiuchi Atsushi, Ogawa Etsushi, Suzuki Haruo, Ueda Keisuke
Department of Cardiovascular Surgery, Teikyo University School of Medicine.
Int Heart J. 2010 Jan;51(1):47-50. doi: 10.1536/ihj.51.47.
We initiated an original papillary muscle head approximation procedure, commonly known as Sandwich plasty, for the treatment of ischemic mitral regurgitation (MR). In this study, we evaluated the appropriateness of this procedure for functional MR associated with aortic valve disease. Fifteen patients who had undergone Sandwich plasty combined with aortic valve surgery were included in this study. The mean age of the patients was 69 years. Predominant aortic valve diseases were regurgitation in 8 patients and stenosis in 7 patients. Aortic valve replacement was performed in 14 patients and David surgery in one. The mitral valve was approached through the aortic annulus in 9 patients (the transaortic group). Six other patients with mitral valve annulus of 30 mm or larger underwent concomitant mitral ring-annuloplasty through a left atrial incision (the LA group). The tenting height of the mitral valve and left ventricle diastolic diameter significantly decreased after surgery in both groups. After surgery, residual moderate or mild MR was detected in two patients in the transaortic group. In the LA group, residual mitral regurgitation was not detected. In the follow-up study, prominent MR occurred in two patients in the transaortic group. The MR free rate two years after surgery was 83% in the total patient population. Sandwich plasty was simple and effective in the treatment of functional mitral regurgitation combined with aortic valve surgery. A transaortic approach is effective in obviating a separate left atriotomy and reducing operation time.
我们开展了一种原创的乳头肌头靠拢术，即通常所说的“三明治成形术”，用于治疗缺血性二尖瓣反流（MR）。在本研究中，我们评估了该手术治疗与主动脉瓣疾病相关的功能性MR的适用性。本研究纳入了15例接受三明治成形术联合主动脉瓣手术的患者。患者的平均年龄为69岁。主要的主动脉瓣疾病中，8例为反流，7例为狭窄。14例患者接受了主动脉瓣置换术，1例接受了David手术。9例患者通过主动脉瓣环处理二尖瓣（经主动脉组）。另外6例二尖瓣环直径为30mm或更大的患者通过左心房切口同期进行二尖瓣环成形术（左心房组）。两组术后二尖瓣的帐篷高度和左心室舒张直径均显著降低。术后，经主动脉组有2例患者检测到残留中度或轻度MR。左心房组未检测到残留二尖瓣反流。在随访研究中，经主动脉组有2例患者出现明显的MR。全体患者术后两年的无MR率为83%。三明治成形术在治疗与主动脉瓣手术联合的功能性二尖瓣反流方面简单有效。经主动脉入路在避免单独的左心房切开和减少手术时间方面有效。
