Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Japan.
Ann Thorac Surg. 2011 Dec;92(6):2097-102; discussion 2102-3. doi: 10.1016/j.athoracsur.2011.07.087.
Quadrangular resection is a standard repair technique for prolapsing posterior leaflet; however, systolic anterior motion (SAM) sometimes occurs. Butterfly resection combines a triangular resection from the prolapsing edge and a reverse triangular resection to the annulus to remove redundancy, reduce leaflet height without annular plication, and minimize SAM. We assessed short-term and midterm outcomes and mitral leaflet configuration after repair vs quadrangular resection.
Between 2002 and 2009, 53 patients underwent posterior leaflet resection with mitral annuloplasty, including quadrangular resection in 24 and butterfly resection in 29.
The butterfly group had a significantly larger mean ring size (29.0 vs 27.8 mm, p = 0.04). SAM occurred in 2 patients in the quadrangular group and in none in the butterfly group. SAM completely resolved in 1 patient after inotropes were weaned, but the other needed a mitral valve replacement. Predischarge echocardiography showed the butterfly group had a significantly larger anterior leaflet/posterior leaflet ratio (3.05 vs 1.53, p < 0.01) and greater length from the coaptation point to the septum (2.91 vs 2.50 cm, p = 0.02) than the quadrangular group. Measurements at 3 months showed that the differences between the two groups persisted. During follow-up, no patients died or needed reoperation for recurrence. Moderate mitral regurgitation occurred in 1 in the quadrangular group.
Butterfly resection can be safely performed without SAM and is durable in midterm follow-up. By echocardiography, this technique reduces the height of the posterior leaflet and shifts the coaptation point further away from the septum.
四方形切除术是修复脱垂后瓣的标准修复技术；然而，收缩期前向运动（SAM）有时会发生。蝶形切除术结合了从脱垂边缘的三角形切除术和到瓣环的反向三角形切除术，以去除多余组织，在不进行瓣环折叠的情况下减少瓣叶高度，并最大限度地减少 SAM。我们评估了修复后与四方形切除术相比的短期和中期结果以及二尖瓣瓣叶形态。
在 2002 年至 2009 年间，53 例患者接受了后瓣切除术和二尖瓣瓣环成形术，其中 24 例采用四方形切除术，29 例采用蝶形切除术。
蝶形组的平均瓣环尺寸明显更大（29.0 毫米对 27.8 毫米，p = 0.04）。SAM 在四方形组的 2 例患者中发生，而在蝶形组中则没有发生。SAM 在 1 例患者中在停用正性肌力药物后完全缓解，但另 1 例患者需要二尖瓣置换术。出院前超声心动图显示，蝶形组的前瓣/后瓣比值（3.05 对 1.53，p < 0.01）和从衔接点到间隔的距离（2.91 厘米对 2.50 厘米，p = 0.02）明显大于四方形组。3 个月时的测量结果表明两组之间的差异仍然存在。在随访期间，没有患者死亡或因复发需要再次手术。四方形组中有 1 例发生中度二尖瓣反流。
蝶形切除术可以安全进行，且在中期随访中持久。通过超声心动图，该技术降低了后瓣叶的高度，并将衔接点进一步移离间隔。
