Tabata Minoru, Nishida Hidefumi, Watanabe Shun, Uchimuro Tomoya, Takanashi Shuichiro
Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu-shi, Chiba, 279-0001, Japan.
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu, Japan.
Gen Thorac Cardiovasc Surg. 2020 Mar;68(3):233-239. doi: 10.1007/s11748-019-01177-5. Epub 2019 Jul 17.
Interscallop indentation closure is a useful adjunctive technique which presents several different effects in repairing degenerative mitral regurgitation. However, there are some concerns that it might reduce mitral valve area by restricting the posterior leaflet mobility. We aim to assess postoperative echocardiographic findings after mitral valve repair using this technique.
Between January 2009 and December 2015, 897 patients underwent mitral valve repair for degenerative mitral regurgitation at our institutions. We reviewed 98 patients in which we used indentation closure technique, and we analyzed operative and echocardiographic data.
Ring annuloplasty and concomitant repair techniques such as leaflet resection and neochordal placement were used in all patients. Specific purposes of indentation closure included gap closure (n = 57), prolapse repair (n = 11), leaflet redundancy repair (n = 16), and leaflet deficiency repair (n = 12). Eleven patients had double indentation closure. Postoperative pre-discharge echocardiography showed no moderate or greater residual mitral regurgitation, mean transmitral pressure gradient of 3.4 ± 1.4 mmHg, and mitral valve area of 2.7 ± 0.7 cm. Follow-up echocardiography performed at 43.7 ± 23.9 months after surgery showed six cases (6.4%) with recurrent moderate or greater mitral regurgitation, mean transmitral pressure gradient of 3.3 ± 1.3 mmHg, and mitral valve area of 2.5 ± 0.6 cm.
Interscallop indentation closure is a simple and effective adjunctive technique which can be used for several different purposes. It achieves excellent control of mitral regurgitation with preserved mitral valve area when it is used in addition to standard mitral valve repair techniques in selected cases.
扇贝间压迹闭合术是一种有用的辅助技术，在修复退行性二尖瓣反流方面呈现出几种不同的效果。然而，有人担心它可能会通过限制后叶活动度而减小二尖瓣面积。我们旨在评估使用该技术进行二尖瓣修复术后的超声心动图检查结果。
2009年1月至2015年12月期间，我们机构有897例患者因退行性二尖瓣反流接受了二尖瓣修复术。我们回顾了其中使用压迹闭合技术的98例患者，并分析了手术和超声心动图数据。
所有患者均采用了瓣环成形术以及诸如瓣叶切除和新腱索植入等联合修复技术。压迹闭合的具体目的包括间隙闭合（n = 57）、脱垂修复（n = 11）、瓣叶冗余修复（n = 16）和瓣叶缺损修复（n = 12）。11例患者进行了双重压迹闭合。术后出院前超声心动图显示无中度或更严重的残余二尖瓣反流，平均跨二尖瓣压力阶差为3.4±1.4 mmHg，二尖瓣面积为2.7±0.7 cm²。术后43.7±23.9个月进行的随访超声心动图显示，6例（6.4%）出现复发性中度或更严重的二尖瓣反流，平均跨二尖瓣压力阶差为3.3±1.3 mmHg，二尖瓣面积为2.5±0.6 cm²。
扇贝间压迹闭合术是一种简单有效的辅助技术，可用于多种不同目的。在特定病例中，当它与标准二尖瓣修复技术联合使用时，能在保留二尖瓣面积的情况下出色地控制二尖瓣反流。
