Lohchab Shamsher Singh, Laller Kuldeep Singh, Taxak Susheela, Johar Sanjay
Department of Cardiac Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Asian Cardiovasc Thorac Ann. 2011 Jun;19(3-4):232-7. doi: 10.1177/0218492311409060.
Chordal transfer and chordal replacement techniques have been quite successful for repair of anterior mitral leaflet prolapse in degenerative disease, but largely unexplored in rheumatic patients. To extend the scope of valve repair, we assessed the chordal transfer technique for correction of anterior mitral leaflet prolapse in 57 patients with rheumatic mitral regurgitation, who were treated between October 2008 and March 2010. There were 36 women and 21 men with a mean age of 25 ± 7.4 years. Normal chordae and a strip of leaflet tissue were transferred from the posterior leaflet to the free edge of the anterior leaflet; the posterior leaflet was repaired in the same manner as after quadrangular resection. Additional procedures were commissurotomy in 19 patients, aortic valve replacement in 1, tricuspid repair in 5, and cryo maze operations in 21. There was no hospital mortality. One (1.7%) patient had acute renal failure but recovered fully. There was moderate regurgitation in one patient who had undergone simultaneous aortic valve replacement. At a mean follow-up of 6.2 ± 2 months, 56/57 (98.2%) patients were asymptomatic with no significant mitral regurgitation.
腱索转移和腱索置换技术在退行性疾病导致的二尖瓣前叶脱垂修复中颇为成功，但在风湿性患者中很大程度上未被探索。为扩大瓣膜修复的范围，我们评估了腱索转移技术在2008年10月至2010年3月期间接受治疗的57例风湿性二尖瓣反流患者中纠正二尖瓣前叶脱垂的效果。其中有36名女性和21名男性，平均年龄为25±7.4岁。正常腱索和一条瓣叶组织从后叶转移至前叶游离缘；后叶采用与四边形切除术后相同的方式进行修复。另外19例患者进行了交界切开术，1例进行了主动脉瓣置换术，5例进行了三尖瓣修复，21例进行了冷冻迷宫手术。无院内死亡病例。1例（1.7%）患者出现急性肾衰竭，但已完全康复。1例同时接受主动脉瓣置换术的患者存在中度反流。平均随访6.2±2个月时，57例患者中有56例（98.2%）无症状，无明显二尖瓣反流。
