Furukawa Kojiro, Kamohara Keiji, Itoh Manabu, Furutachi Akira, Morokuma Hiroyuki, Morita Shigeki
Department of Thoracic and Cardiovascular Surgery, Saga University, Saga, Japan.
Kyobu Geka. 2012 Apr;65(4):273-7.
We have performed a simple and uniform technique for reconstruction of artificial chordae in patients with anterior mitral prolapse since 1994. In this study, we investigated the long-term clinical and echocardiographic results of chordae replacement with Gore-Tex sutures for anterior mitral leaflet prolapse.
A pair of Gore-Tex sutures is passed through a small autologous pericardium and tied on one side of the pericardium. Double-armed mattress stitches on the side without a knot are passed through the head of the papillary muscle and another small pericardium and then tied down. Using this simple technique, 2 pairs of artificial chordae are made. The length of the artificial chordae is determined during the leak test. Chordal replacement with this technique was performed in 30 patients (mean age, 59.3 years) with anterior mitral leaflet prolapse. Echocardiography was performed annually in these patients. Follow-up ranged from 0.2~16.2( 8.0±5.1) years.
There were no hospital deaths. Twenty-one patients had no mitral regurgitation( MR) and the others had trivial or mild MR. There were 2 reoperations and 4 cases with recurrent moderate MR in this series. Kaplan-Meier survival and freedom from reoperation at 15 years were 84% and 93%,respectively. Overall, freedom from recurrent moderate or severe MR at 15 years was 81%.
Our simple chordae replacement technique with Gore-Tex sutures for anterior mitral prolapse, results in good long-term durability. To avoid recurrence of regurgitation, intraoperative complete repair is essential.
自1994年以来，我们已开展了一项用于二尖瓣前叶脱垂患者人工腱索重建的简单且统一的技术。在本研究中，我们调查了采用戈尔特斯缝线置换腱索治疗二尖瓣前叶脱垂的长期临床及超声心动图结果。
将一对戈尔特斯缝线穿过一小片自体心包，并在心包的一侧打结。未打结一侧的双臂褥式缝线穿过乳头肌头部及另一片小心包，然后收紧。采用这种简单技术制作2对人工腱索。人工腱索的长度在漏血试验时确定。采用该技术对30例（平均年龄59.3岁）二尖瓣前叶脱垂患者进行腱索置换。对这些患者每年进行超声心动图检查。随访时间为0.2至16.2（8.0±5.1）年。
无院内死亡病例。21例患者无二尖瓣反流（MR），其余患者有轻微或轻度MR。本系列中有2例再次手术，4例出现复发性中度MR。15年时的Kaplan-Meier生存率和免于再次手术率分别为84%和93%。总体而言，15年时免于复发性中度或重度MR的比例为81%。
我们采用戈尔特斯缝线置换腱索治疗二尖瓣前叶脱垂的简单技术，长期耐久性良好。为避免反流复发，术中进行完全修复至关重要。
