Dreyfus Gilles D, Dulguerov Filip
Cardiac Surgery, Hopital Europeen Georges Pompidou, Paris, Ile de France, 75015, France.
Hôpitaux Universitaires de Genève, Genève, Switzerland.
J Card Surg. 2022 Dec;37(12):4047-4052. doi: 10.1111/jocs.16993. Epub 2022 Oct 2.
Mitral regurgitation in Barlow disease may still be challenging to be repaired. Most often it involves the posterior leaflet. Many techniques and concepts are currently available; the main goal being to restore a good surface of coaptation. Basic principles such as thorough analysis is still required whatever the approach to assess excess tissue height, width, and prolapse. Nowadays it seems that two different ways of treating mitral prolapse coexist: the nonresection one and the resection one. Both will be discussed and analyzed. Similarly, the use of artificial chordae seems to have a preponderant role to support the free edge and correct a prolapse. Native secondary chord transfer are easy and reliable but seem abandoned by many. Anterior leaflet prolapse is also dealt with and fewer options are available to address this leaflet. Then commissural prolapse is mentioned. It is an important area of the valve which should deserve better treatment than commissuroplasty. Finally, a special entity will be described; mitro annular disjunction. The approach is not or no longer an issue as only good long-term results are important in an era where percutaneous therapy is the only noninvasive technique.
巴洛病中的二尖瓣反流修复仍具有挑战性。多数情况下累及后叶。目前有多种技术和理念；主要目标是恢复良好的瓣叶贴合面。无论采用何种方法评估多余组织的高度、宽度和脱垂情况，全面分析等基本原则仍是必需的。如今，治疗二尖瓣脱垂似乎存在两种不同方式：非切除方式和切除方式。将对这两种方式进行讨论和分析。同样，使用人工腱索似乎在支撑游离缘和纠正脱垂方面起着重要作用。自体二级腱索转移操作简便且可靠，但似乎已被许多人摒弃。前叶脱垂也会涉及，处理该瓣叶的选择较少。接着会提到瓣叶交界脱垂。这是瓣膜的一个重要区域，应得到比交界成形术更好的治疗。最后，将描述一种特殊情况；二尖瓣环分离。在经皮治疗是唯一非侵入性技术的时代，方法不再是问题，重要的只是良好的长期效果。
