Sakaguchi Taichi, Totsugawa Toshinori, Hayashida Akihiro, Ryomoto Masaaki, Sekiya Naosumi, Tamura Kentaro, Hiraoka Arudo, Yoshitaka Hidenori
Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
J Card Surg. 2020 Jul;35(7):1471-1476. doi: 10.1111/jocs.14615. Epub 2020 May 7.
Mitral regurgitation (MR) in Barlow's disease is complicated because of its mixed pathophysiology, leaflet billowing with or without organic prolapse, and abnormal annular dynamics that cause functional prolapse. Complex repair techniques, including aggressive leaflet resection and implantation of multiple artificial chordae, are conventionally performed; nevertheless, these are technically demanding, especially when performed using a minimally invasive approach. We aimed to standardize the repair technique for Barlow's disease and developed stepwise repair techniques.
Of 292 patients who underwent isolated minimally invasive mitral valve repair for MR, 29 patients (seven females, age 49 ± 10 years) were found to have Barlow's disease. Our repair technique consists of the following three steps: (a) stabilization of the mitral annulus by placing annuloplasty ring sutures; (b) distinction between organic and functional prolapse by a saline injection test; and (c) targeted repair for organic prolapse by leaflet resection or chordal replacement.
Surgical techniques included leaflet resection in 22 patients, chordal replacement in 19 patients, and ring annuloplasty only in one patient. These procedures were applied to the anterior leaflet in one, posterior leaflet in eight, and both leaflets in 19 patients. The median annuloplasty ring size was 34 mm. The repair success rate was 100%. No patients developed moderate or greater MR during a mean follow-up period of 36 ± 21 months.
A stepwise repair strategy facilitates mitral valve repair in patients with Barlow's disease and provides excellent outcomes even via a minimally invasive approach.
巴洛氏病中的二尖瓣反流（MR）情况复杂，因其病理生理混合，存在伴或不伴器质性脱垂的瓣叶膨出以及导致功能性脱垂的异常瓣环动力学。传统上采用复杂的修复技术，包括积极的瓣叶切除和多条人工腱索植入；然而，这些技术要求较高，尤其是采用微创方法时。我们旨在规范巴洛氏病的修复技术并开发逐步修复技术。
在292例行孤立性微创二尖瓣反流修复术的患者中，发现29例（7例女性，年龄49±10岁）患有巴洛氏病。我们的修复技术包括以下三个步骤：（a）通过放置瓣环成形环缝线稳定二尖瓣瓣环；（b）通过盐水注射试验区分器质性和功能性脱垂；（c）针对器质性脱垂进行瓣叶切除或腱索置换的靶向修复。
手术技术包括22例患者行瓣叶切除，19例患者行腱索置换，仅1例患者行瓣环成形术。这些操作应用于1例患者的前叶、8例患者的后叶以及19例患者的双叶。瓣环成形环的中位尺寸为34mm。修复成功率为100%。在平均36±21个月的随访期内，无患者出现中度或更严重的二尖瓣反流。
逐步修复策略有助于巴洛氏病患者的二尖瓣修复，即使通过微创方法也能取得优异的效果。
