Gregori Francisco, Leal João Carlos, Braile Domingo Marcolino
Cardiac Surgery Division, University of Londrina-Paraná School of Medicine, João de Freitas Hospital, Arapongas, Paraná.
Heart Surg Forum. 2010 Feb;13(1):E17-20. doi: 10.1532/HSF98.20091053.
The aim of this study was to assess by Doppler echocardiography (ECO) the functioning of the mitral valve apparatus in patients who have undergone implantation of standardized bovine pericardium chordae (SBPC) for replacement of ruptured or elongated chordae tendineae with significant thinning.
SBPC were implanted in 31 patients who had mitral insufficiency due to rupture of chordae tendinae or elongated chordae with significant thinning. Patient ages ranged from 19 to 85 years (mean of 58 years). The most frequent cause of mitral insufficiency was fibroelastic degeneration in 25 patients (80.6%). The SBPC were fashioned as a set, joined at their extremities by 2 polyester-reinforced rods forming a monobloc. The SBPC were 2-mm wide and were positioned parallel to one another at a distance of 3 mm. Each set of SBPC had a corresponding measurer, and their length ranged from 20 to 35 mm. In 21 patients (67.7%) the SBPC were implanted in the posterior leaflet and in 10 patients (32.3%) in the anterior leaflet (in 2 patients concurrently in the anterior and posterior leaflets). All patients were assessed by ECO postoperatively, with a 20-month mean follow-up time (range 6-45 months).
One patient (3.2%) died of pulmonary embolism during the early postoperative period. Postoperative ECO showed absence of mitral regurgitation in 17 patients (54.8%), mild regurgitation in 9 (29.0%), and mild-to-moderate regurgitation in 4 (12.9%). Opening and mobility of the mitral valve were normal in the 30 surviving patients.
The ECO revealed good functionality of the mitral valve apparatus with appropriate leaflet coaptation in patients who had undergone implantation of SBPC for replacement of ruptured or elongated and thinned chordae. A longer follow-up is required to assess absence of calcification and/or degeneration of the SBPC.
本研究旨在通过多普勒超声心动图（ECO）评估接受标准化牛心包腱索（SBPC）植入术以替换破裂或延长且明显变薄的腱索的患者二尖瓣装置的功能。
31例因腱索破裂或延长且明显变薄而导致二尖瓣关闭不全的患者接受了SBPC植入。患者年龄在19至85岁之间（平均58岁）。二尖瓣关闭不全最常见的原因是25例（80.6%）的纤维弹性组织变性。SBPC制成一套，其末端通过2根聚酯增强杆连接形成一个整体。SBPC宽2毫米，彼此平行放置，间距为3毫米。每套SBPC都有一个相应的测量器，其长度在20至35毫米之间。21例（67.7%）患者的SBPC植入后叶，10例（32.3%）植入前叶（2例同时植入前叶和后叶）。所有患者术后均接受ECO评估，平均随访时间为20个月（范围6至45个月）。
1例患者（3.2%）在术后早期死于肺栓塞。术后ECO显示，17例患者（54.8%）无二尖瓣反流，9例（29.0%）有轻度反流，4例（12.9%）有轻度至中度反流。30例存活患者的二尖瓣开放和活动正常。
ECO显示，接受SBPC植入以替换破裂、延长和变薄腱索的患者，其二尖瓣装置功能良好，瓣叶对合适当。需要更长时间的随访来评估SBPC是否无钙化和/或退变。
