Alizadeh-Ghavidel Alireza, Samiei Niloofar, Javadikasgari Hoda, Bashirpour Kamiar
Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Mechanical Engineering Departments, Amirkabir University of Technology, Tehran, IR Iran.
Res Cardiovasc Med. 2013 Nov;2(4):186-9. doi: 10.5812/cardiovascmed.12146. Epub 2013 Oct 28.
Mitral valve repair has shown superior results compared to mitral valve replacement in patients with mitral valve prolapse. Using premeasured neochordae (the loop technique) has been proposed for both anterior and posterior leaflet repairs. However, there are two major problems that are usually experienced using this method. One is deciding the length of the neo-chordae, and the other is tying the knot at the intended length.
This study introduced a new technology in mitral valve repair that reduces the complexity of making neo-chordae loops, especially in minimally invasive surgeries.
Neochordameter is a new device which utilizes preoperative transthoracic echocardiography to determine the exact length of required neochordae and enable surgeons to make neochordae loops before starting the cardiopulmonary bypass. In this study, we applied this technique in mitral valve repair of three patients.
Two of these patients were male and the other one was female. All of them had severe mitral regurgitation requiring anterior leaflet repair. Total eight neochordae loops were used in these patients. No change in the length of neochordae was required after saline test and all of these patients had none or trivial mitral regurgitation by intraoperative and follow up transesophageal echocardiography. No complication was seen in six-month follow up.
The ability of this technology in developing premeasured neo-chordae loops with accurate sizes and not needing the post-implantation length adjustment which is efficient in reducing the complexity of both minimally invasive and conventional surgeries are the issues which is going to be regarded .
对于二尖瓣脱垂患者，二尖瓣修复术的效果已显示优于二尖瓣置换术。有人提出使用预先测量好的新腱索（套环技术）进行前叶和后叶修复。然而，使用这种方法通常会遇到两个主要问题。一个是确定新腱索的长度，另一个是在预期长度处打结。
本研究介绍了一种二尖瓣修复的新技术，该技术降低了制作新腱索套环的复杂性，尤其是在微创手术中。
新腱索测量仪是一种新设备，它利用术前经胸超声心动图确定所需新腱索的确切长度，并使外科医生能够在开始体外循环前制作新腱索套环。在本研究中，我们将该技术应用于3例患者的二尖瓣修复。
其中2例患者为男性，另1例为女性。他们均有严重二尖瓣反流，需要进行前叶修复。这些患者共使用了8个新腱索套环。盐水测试后新腱索长度无需改变，术中及术后经食管超声心动图检查显示所有患者无或仅有微量二尖瓣反流。6个月随访未见并发症。
该技术能够制作尺寸精确的预先测量好的新腱索套环，且无需植入后调整长度，这对于降低微创手术和传统手术的复杂性均有效，这些问题值得关注。
