Cohn L H, DiSesa V J, Couper G S, Peigh P S, Kowalker W, Collins J J
Department of Surgery, Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 1989 Nov;98(5 Pt 2):987-92; discussion 992-3.
From 1984 to 1988, 129 mitral valve reconstructions were done for primary pure mitral regurgitation. Sixty-two (48%) were done for myxomatous degeneration and prolapse of the mitral valve. Anterior leaflet resection was performed in seven patients, posterior leaflet resection in 46, anteroposterior resection in four; five patients received only a ring annuloplasty. Eight patients had coronary bypass grafts. Twenty-four patients received a Carpentier-Edwards annuloplasty ring, 24 a Duran ring, and 14 patients had no ring. Follow-up was 1 to 50 months (mean, 13 months). No patient was lost to follow-up. There was one operative death from gastrointestinal bleeding and two late deaths (one from suicide and one from a myocardial infarction), and the probability of survival at 48 months was 84% +/- 15%. There were no thromboembolic episodes or episodes of endocarditis. However, there were five reoperations (9%) with freedom from reoperation at 48 months of 85% +/- 5%. There was one major anticoagulant hemorrhage. Freedom from all morbidity at 48 months was 81% +/- 8%. Postoperative echocardiographic data in the three different groups of patients undergoing repair on the basis of annuloplasty treatment showed that the peak gradient was less and the valve area was slightly greater with no annuloplasty ring.
1984年至1988年期间，针对原发性单纯二尖瓣反流进行了129例二尖瓣重建手术。其中62例（48%）是因二尖瓣黏液样变性和脱垂而进行的手术。7例患者进行了前叶切除术，46例进行了后叶切除术，4例进行了前后叶切除术；5例患者仅接受了瓣环成形术。8例患者进行了冠状动脉搭桥术。24例患者植入了Carpentier-Edwards瓣环成形环，24例植入了Duran环，14例患者未植入环。随访时间为1至50个月（平均13个月）。无患者失访。有1例因胃肠道出血导致的手术死亡和2例晚期死亡（1例自杀，1例心肌梗死），48个月时的生存率为84%±15%。无血栓栓塞事件或心内膜炎发作。然而，有5例再次手术（9%），48个月时无再次手术的概率为85%±5%。有1例严重抗凝剂出血。48个月时无所有并发症的概率为81%±8%。在基于瓣环成形术治疗进行修复的三组不同患者中，术后超声心动图数据显示，未使用瓣环成形环时，峰值梯度较小，瓣膜面积略大。
