Yanase Yohsuke, Ishikawa Natsuya, Watanabe Manabu, Kimura Sachiko, Higami Tetsuya
Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation.
Ann Thorac Cardiovasc Surg. 2014;20(2):150-4. doi: 10.5761/atcs.oa.12.02159. Epub 2013 Apr 5.
Idiopathic mitral valve chordal rupture is rare among infants. Once it has occurred, acute heart failure progresses, and emergency surgical repair is necessary in most cases. Our surgical experience with idiopathic mitral valve chordal rupture is reported.
From September 2008 to May 2012, four infants (3 males, 1 female; median age 5.5 months) underwent mitral valve plasty for severe mitral valve regurgitation due to prolapse of posterior mitral valve leaflet. Patient history, surgical procedure, operation time, mortality, postoperative echocardiography data (mitral valve regurgitation grade: 0-trivial, mild, moderate, severe, transmitral flow: TMF) and pathology were examined.
Three cases required emergency surgery; 1 case, elective surgery. Intraoperative findings showed chordal rupture of the P2 segment in 3 cases and P1 + P3 segments in 1 case. Quadrangular resection with annular plication was performed for 1 case. Quadrangular resection with annular plication and the Kay procedure were performed for 3 cases. Mitral valve regurgitation improved from severe to trivial-mild in all cases. Pathological examination showed a myxomatous degenerative change in the mitral valve.
Mitral valve plasty was performed for idiopathic mitral valve chordal rupture in infants. The surgical procedures were the same as for adult cases and achieved satisfactory results.
特发性二尖瓣腱索断裂在婴儿中较为罕见。一旦发生，急性心力衰竭会进展，多数情况下需要紧急手术修复。本文报告我们治疗特发性二尖瓣腱索断裂的手术经验。
2008年9月至2012年5月，4例婴儿（3例男性，1例女性；中位年龄5.5个月）因二尖瓣后叶脱垂导致严重二尖瓣反流接受二尖瓣成形术。检查患者病史、手术过程、手术时间、死亡率、术后超声心动图数据（二尖瓣反流分级：0-微量、轻度、中度、重度，二尖瓣血流：TMF）及病理情况。
3例需要急诊手术；1例为择期手术。术中发现3例为P2段腱索断裂，1例为P1 + P3段腱索断裂。1例行四边形切除加瓣环折叠术。3例行四边形切除加瓣环折叠术及凯氏手术。所有病例二尖瓣反流均从重度改善为微量-轻度。病理检查显示二尖瓣黏液样变性。
对婴儿特发性二尖瓣腱索断裂行二尖瓣成形术。手术方法与成人病例相同，取得了满意效果。
