Ishikawa Susumu, Mishima Hideki, Matsunaga Hiroki, Katayama Yasushi
Department of Thoracic and Cardiovascular Surgery Tokyo Metropolitan Bokutoh Hospital Tokyo, Japan.
Surg Technol Int. 2014 Nov;25:207-11.
An original papillary muscle heads approximation procedure, commonly known as a sandwich plasty, has been successfully used for the treatment of functional mitral regurgitation (MR) associated with ischemic cardiomyopathy (ICM) and aortic valve disease (AVD). In this study, we evaluated the availability of this method as the concomitant procedure for the plasty of organic MR in comparison with the operative results in patients with functional MR. Fifty-six patients who underwent sandwich plasty were reviewed, including 45 functional MR (29 ICM and 16 AVD) patients and 11 organic MR patients. The mean age of patients was 67 years. In the organic MR patients, predominant cardiac diseases were solitary MR in six patients and combined valve diseases including aortic valve stenosis in five. Mitral valve changes included prolapse in six patients and moderate cusp thickening with calcification in five. Two heads of the papillary muscle connecting to the choldae of both the anterior and posterior leaflets are fixed with two teflon-pledgeted 3-0 TiCron™ (Covidien, Dublin, Ireland) sutures in order to achieve coaptation of the two leaflets. Prominent MR was observed in a patient with functional MR after surgery, however residual MR was not detected in organic MR patients. The tenting height (coaptation distance) of mitral valve significantly decreased after surgery from 11±1 to 7±2mm in the organic MR patients, which was similar to the results in the functional MR patients (from 12±2 to 7±2 mm). The postoperative mean mitral orifice area in the organic MR patients was 4.3±0.1cm2 without stenosis. Sandwich plasty reduces the distance of choldae connecting to anterior and posterior leaflets and achieves the better coaptation of two leaflets. This procedure is effective in the treatment of both functional and organic MR.
一种最初的乳头肌头部靠拢手术，通常称为三明治成形术，已成功用于治疗与缺血性心肌病（ICM）和主动脉瓣疾病（AVD）相关的功能性二尖瓣反流（MR）。在本研究中，我们将该方法作为器质性MR成形术的同期手术的可行性与功能性MR患者的手术结果进行了比较。回顾了56例行三明治成形术的患者，包括45例功能性MR患者（29例ICM和16例AVD）和11例器质性MR患者。患者的平均年龄为67岁。在器质性MR患者中，主要的心脏疾病为6例单纯性MR和5例合并瓣膜疾病（包括主动脉瓣狭窄）。二尖瓣改变包括6例脱垂和5例瓣叶中度增厚伴钙化。连接前后叶腱索的乳头肌的两个头用两根带垫片的3-0 Ticron™（柯惠医疗，都柏林，爱尔兰）缝线固定，以实现两个瓣叶的对合。一名功能性MR患者术后观察到明显的MR，但器质性MR患者未检测到残余MR。器质性MR患者术后二尖瓣的帐篷高度（对合距离）从11±1显著降至7±2mm，这与功能性MR患者的结果相似（从12±2降至7±2mm）。器质性MR患者术后二尖瓣口平均面积为4.3±0.1cm²，无狭窄。三明治成形术减少了连接前后叶腱索的距离，实现了两个瓣叶更好的对合。该手术对功能性和器质性MR均有效。
