Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 2011 Nov;92(5):1634-7; discussion 1637-8. doi: 10.1016/j.athoracsur.2011.05.123. Epub 2011 Oct 31.
Quadrangular resection with sliding valvuloplasty is the most common technique used to repair the posterior leaflet of the prolapsed mitral valve. Folding valvuloplasty is a simplified repair that does not involve resection and reduces the effective height of the posterior leaflet. We describe medium-term outcomes of patients who underwent folding valvuloplasty at our institution.
From 2002 to 2010, 161 patients underwent folding valvuloplasty at our institution. The primary endpoints in our study of these patients' medium-term outcomes included survival, freedom from reoperation, and echocardiographic evidence of recurrent mitral regurgitation (MR).
The patients' median age was 61 ± 14 years, 68 of the patients (42%) were male, and 146 of the patients (90%) had more than moderate to severe MR. Cardiopulmonary bypass and cross-clamp times were 117 ± 40 minutes and 83 ± 29 minutes, respectively. In addition to folding valvuloplasty, mitral rings with a median size of 38 mm (interquartile range, 34 mm to 38 mm) were used in 155 (96%) of the patients. One patient died during surgery. Medium-term follow-up data were available for all of the patients at a mean of 3.0 ± 1.9 years after folding valvuloplasty. The patients' mean New York Heart Association class decreased significantly, from 2.0 ± 0.9 to 1.1 ± 0.4 (p < 0.0001), from the time of valvuloplasty to their mean medium-term follow-up evaluation. Two patients required reoperative mitral valve repair in the follow-up period. Postoperative echocardiograms were obtained for 142 (88%) patients at a mean of 1.6 ± 1.2 years after valvuloplasty. The patients' mean grade of MR decreased significantly from the time of valvuloplasty to the time of mean medium-term follow up, from 3.8 ± 0.5 (severe) to 0.8 ± 0.8 (trace-mild) (p < 0.0001), with only five patients (3%) having moderate MR at follow-up.
Folding valvuloplasty is durable and provides excellent structural and symptomatic results in patients with mitral prolapse. Given the ease and reproducibility of this technique, it should be offered as a suitable alternative to quadrangular resection for repair of the posterior leaflet in mitral prolapse.
四方形切除术联合滑动瓣膜成形术是修复脱垂二尖瓣后瓣的最常用技术。折叠瓣膜成形术是一种简化的修复方法，不涉及切除，并降低了后瓣的有效高度。我们描述了在我院接受折叠瓣膜成形术患者的中期结果。
2002 年至 2010 年，我院共 161 例患者接受折叠瓣膜成形术。本研究的主要终点是患者的中期结果，包括生存率、免于再次手术率和超声心动图检查显示复发性二尖瓣反流（MR）的证据。
患者的中位年龄为 61 ± 14 岁，68 例（42%）为男性，146 例（90%）患者的 MR 程度超过中度至重度。体外循环和主动脉阻断时间分别为 117 ± 40 分钟和 83 ± 29 分钟。除了折叠瓣膜成形术外，155 例（96%）患者还使用了中位数为 38mm（四分位距为 34mm 至 38mm）的二尖瓣环。1 例患者在手术中死亡。在折叠瓣膜成形术后平均 3.0 ± 1.9 年，所有患者均获得了中期随访数据。患者的纽约心脏病协会心功能分级从瓣膜成形术时的 2.0 ± 0.9 显著降低至随访时的 1.1 ± 0.4（p < 0.0001）。在随访期间，有 2 例患者需要再次进行二尖瓣修复手术。术后 142 例（88%）患者在瓣膜成形术后平均 1.6 ± 1.2 年进行了超声心动图检查。患者的 MR 严重程度从瓣膜成形术到平均中期随访时间显著降低，从 3.8 ± 0.5（重度）降至 0.8 ± 0.8（微量-轻度）（p < 0.0001），随访时只有 5 例（3%）患者有中度 MR。
折叠瓣膜成形术在二尖瓣脱垂患者中是持久的，提供了出色的结构和症状结果。鉴于该技术的简便性和可重复性，它应作为修复二尖瓣脱垂后瓣的四方形切除术的一种合适替代方法。
