Hegeman Romy M J J, Gheorghe Livia L, de Kroon Thomas L, van Putte Bart P, Swaans Martin J, Klein Patrick
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands.
Hospital Universitario Puerta del Mar, Cádiz, Spain.
Front Cardiovasc Med. 2022 Apr 12;9:850700. doi: 10.3389/fcvm.2022.850700. eCollection 2022.
Degenerative mitral regurgitation (DMR) based on posterior leaflet prolapse is the most frequent type of organic mitral valve disease and has proven to be durably repairable in most cases by chordal repair techniques either by conventional median sternotomy or by less invasive approaches both utilizing extracorporeal circulation and cardioplegic myocardial arrest. Recently, several novel transapical chordal repair techniques specifically targeting the posterior leaflet have been developed as a far less invasive and beating heart (off-pump) alternative to port-access mitral repair. In order to perform a safe and effective minimally invasive mitral chordal repair, thorough knowledge of the anatomy of the mitral valve apparatus and adequate use of multimodality imaging both pre- and intraoperatively are fundamental. In addition, comprehensive understanding of the available novel devices, their delivery systems and the individual procedural steps are required.
基于后叶脱垂的退行性二尖瓣反流（DMR）是最常见的器质性二尖瓣疾病类型，并且已被证明在大多数情况下，通过传统正中胸骨切开术或利用体外循环和心脏停搏的侵入性较小的方法进行腱索修复技术，都能持久修复。最近，已经开发了几种专门针对后叶的新型经心尖腱索修复技术，作为端口入路二尖瓣修复的侵入性小得多的不停跳（非体外循环）替代方法。为了进行安全有效的微创二尖瓣腱索修复，术前和术中对二尖瓣装置的解剖结构有透彻的了解以及充分使用多模态成像至关重要。此外，还需要全面了解可用的新型器械、其输送系统和各个手术步骤。
