Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
Eur J Cardiothorac Surg. 2011 Mar;39(3):407-9. doi: 10.1016/j.ejcts.2010.06.017. Epub 2010 Aug 8.
Systemic calcifications are often seen in patients with end-stage renal failure, who need long-term hemodialysis. When patients with severe calcification of the mitral-valve annulus undergo mitral-valve replacement (MVR), complete debridement of the calcified tissues may result in fatal complications such as rupture of the left ventricle or injury to the coronary artery. We describe a novel technique of MVR for a severely calcified mitral annulus and leaflet, in which only the anterior leaflet is excised, preserving the posterior leaflet to prevent fatal complications. We passed 2/0 polyester mattress sutures through the mitral annulus from the left ventricle to the left atrium and fixed the preserved posterior leaflet to the posterior mitral annulus and prosthetic valve. The mitral valve was replaced using a St. Jude Medical mechanical heart valve with a specific structure and a hinge that shifts to the left atrial side and most of the leaflet moves within its housing. This structure enables this procedure to be performed without the excision of a severely calcified posterior mitral leaflet and annulus. Our technique may prevent the fatal complications that can be caused by debridement or excision of severely calcified mitral apparatus.
系统性钙化在需要长期血液透析的终末期肾衰竭患者中很常见。当二尖瓣环严重钙化的患者接受二尖瓣置换术（MVR）时，彻底清除钙化组织可能会导致致命并发症，如左心室破裂或冠状动脉损伤。我们描述了一种用于严重钙化的二尖瓣环和瓣叶的新型 MVR 技术，其中仅切除前瓣叶，保留后瓣叶以防止致命并发症。我们将 2/0 聚酯褥式缝线从左心室穿过二尖瓣环至左心房，并将保留的后瓣叶固定在二尖瓣后环和人工瓣膜上。使用具有特定结构和铰链的圣犹达机械心脏瓣膜替换二尖瓣，该铰链向左心房侧移动，大部分瓣叶在其外壳内移动。这种结构使我们能够在不切除严重钙化的后二尖瓣瓣叶和环的情况下进行此操作。我们的技术可以防止因严重钙化的二尖瓣装置清创或切除而引起的致命并发症。
