Nakajima Masato, Tsuchiya Koji, Honda Yoshihiro, Koshiyama Hiroshi
Department of Cardiovascular Surgery, Yamanashi Central Hospital, Kofu, Yamanashi, Japan.
Gen Thorac Cardiovasc Surg. 2010 Jun;58(6):271-5. doi: 10.1007/s11748-009-0559-1. Epub 2010 Jun 13.
Leaflet folding plasty was introduced as an effective technique to avoid systolic anterior motion (SAM) after mitral valve repair. The purpose of this study was to investigate the midterm outcome of leaflet folding plasty following a review of our 10-year experience.
Between October 1997 and May 2008, a total of 45 patients with mitral valve regurgitation due to posterior leaflet prolapse were operated on using leaflet folding plasty (63% of posterior leaflet repair and 28% of overall mitral valve repair during the same period). The group comprised 29 men and 16 women, with a mean age of 63.2 years. There were 44 patients with degenerative valve disease and 1 with healed infective endocarditis. The prolapsed scallop were P1 in 1, P2 in 33, and P3 in 11 patients. Anterior mitral leaflet involvement was seen in two patients.
Mitral valve repair was performed in all patients. SAM with residual mitral regurgitation was observed in two patients, with one requiring intraoperative revision. The 30-day mortality was 2.2% (one patient died from intestinal complications). The mean follow-up period for survivors was 38.1 months (range 1-127 months). The 1- and 5-year actuarial survival rates were 97.8% and 93.7%, respectively. None of the patients required reoperation during follow-up.
Midterm outcome of leaflet folding plasty for mitral valve repair was satisfactory. This technique accomplishes mitral valve repair safely in patients with mitral regurgitation due to posterior prolapse, with acceptable intermediate-term freedom from reintervention.
瓣叶折叠成形术作为一种有效技术被引入，用于避免二尖瓣修复术后的收缩期前向运动（SAM）。本研究的目的是在回顾我们10年经验的基础上，探讨瓣叶折叠成形术的中期结果。
1997年10月至2008年5月，共有45例因后叶脱垂导致二尖瓣反流的患者接受了瓣叶折叠成形术（同期后叶修复的占63%，二尖瓣整体修复的占28%）。该组包括29名男性和16名女性，平均年龄63.2岁。有44例患者患有退行性瓣膜病，1例患有愈合的感染性心内膜炎。脱垂的扇贝形结构在1例患者中为P1，33例患者中为P2，11例患者中为P3。2例患者可见二尖瓣前叶受累。
所有患者均进行了二尖瓣修复。2例患者观察到伴有残余二尖瓣反流的SAM，其中1例需要术中修正。30天死亡率为2.2%（1例患者死于肠道并发症）。幸存者的平均随访期为38.1个月（范围1 - 127个月）。1年和5年实际生存率分别为97.8%和93.7%。随访期间无患者需要再次手术。
二尖瓣修复的瓣叶折叠成形术中期结果令人满意。该技术能安全地完成因后叶脱垂导致二尖瓣反流患者的二尖瓣修复，并在中期具有可接受的无需再次干预率。
