Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Eur J Cardiothorac Surg. 2013 Sep;44(3):485-9; discussion 489. doi: 10.1093/ejcts/ezt092. Epub 2013 Feb 28.
Mitral valve repair techniques for degenerative disease typically entail leaflet resection or neochordal construction, which may require extensive resection, leaflet detachment/reattachment, reliance on diseased native chords or precise neochordal measuring. Occasionally, impaired leaflet mobility, reduced coaptation surface and systolic anterior motion (SAM) may result. We describe a novel technique for addressing posterior leaflet prolapse/flail, which both simplifies repair and addresses these issues.
Fifty-four patients (age 62 ± 11 years) with degenerative MR underwent this new repair, 36 of whom minimally-invasively. A CV5 Gore-Tex suture was placed into the posterior left ventricular myocardium underneath the prolapsing segment as an anchor. This suture was then used to imbricate a portion of the prolapsed segment into the ventricle, creating a smooth, broad, non-prolapsed coapting surface on a leaflet with preserved mobility, additional neochordal support and posteriorly positioned enough to preclude SAM.
Repair was successful in all patients. The mean MR grade was reduced from +3.8 to +0.1 with 50 of 54 patients having zero MR and 4 of the 54 having trace or mild MR. All patients had proper antero-posterior location of the coaptation line of a mean length of 10.2 mm, and preserved posterior leaflet mobility. No patients had SAM or mitral stenosis. All patients were discharged and are currently doing well.
This new technique facilitated efficient single-suture repair of the prolapsed posterior leaflet mitral regurgitation without the need for resection or sliding annuloplasty. It precluded the need for precise neochordal measurement and preserved the leaflet coaptation surface.
退行性病变二尖瓣修复技术通常需要瓣叶切除术或人工腱索重建，这可能需要广泛的切除、瓣叶分离/再附着、依赖病变的固有腱索或精确的人工腱索测量。偶尔，会导致瓣叶活动受限、结合面积减小和收缩期前向运动（SAM）。我们描述了一种治疗后瓣叶脱垂/瓣叶游离的新方法，该方法既简化了修复，又解决了这些问题。
54 例退行性二尖瓣关闭不全患者（年龄 62±11 岁）接受了这种新的修复，其中 36 例采用微创方法。在脱垂节段下方的左心室后侧壁心肌中放置一条 CV5 Gore-Tex 缝线作为锚点。然后，这条缝线被用来将脱垂节段的一部分嵌入心室，在保留瓣叶活动度的基础上，将脱垂段的一部分缝合到瓣叶上，形成一个平滑、宽阔、非脱垂的结合面，增加了人工腱索的支持，并将其置于足够的后位，以防止 SAM。
所有患者的修复均成功。MR 分级从+3.8 级降至+0.1 级，54 例中有 50 例 MR 为零级，4 例为微量或轻度 MR。所有患者的前-后瓣叶结合线均位于适当位置，平均长度为 10.2mm，且后瓣叶活动度良好。无 SAM 或二尖瓣狭窄。所有患者均出院，目前情况良好。
这种新技术通过单根缝线就能有效地修复脱垂的后瓣叶二尖瓣关闭不全，而无需进行瓣叶切除或滑动瓣环成形术。它避免了对精确的人工腱索测量的需求，并保留了瓣叶的结合面。
