风湿性疾病中的全腱索保留二尖瓣置换术：一则警示
Total Chordal Sparing Mitral Valve Replacement in Rheumatic Disease: A Word of Caution.
作者信息
Kessel Samuel M, Hawkins Robert B, Yarboro Leora T, Ailawadi Gorav
机构信息
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
出版信息
Ann Thorac Surg. 2017 Jul;104(1):e47-e48. doi: 10.1016/j.athoracsur.2017.01.106.
Total chordal preservation is the standard for mitral valve replacement to maintain long-term left ventricular geometry. Whereas it is appropriate for functional and degenerative mitral regurgitation, the role of chordal sparing in rheumatic valve disease is less well understood, with limited evidence supporting total chordal sparing. Inasmuch as this autoimmune disease affects the subvalvular apparatus in addition to the leaflets, it can be expected to continue after surgical repair. Here we present 2 patients who experienced adverse events associated with total chordal sparing mitral replacement as a result of disease progression with rapid fibrous growth causing inflow obstruction and early prosthetic valve failure.
保留全部腱索是二尖瓣置换术维持长期左心室形态的标准。虽然这适用于功能性和退行性二尖瓣反流，但保留腱索在风湿性瓣膜病中的作用尚不太明确，支持保留全部腱索的证据有限。由于这种自身免疫性疾病除了影响瓣叶外还会影响瓣下结构，因此预计在手术修复后仍会持续存在。在此，我们报告2例患者，由于疾病进展导致快速纤维组织生长，引起流入道梗阻和人工瓣膜早期功能障碍，他们经历了与保留全部腱索的二尖瓣置换相关的不良事件。
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