Tsuda Kazumasa, Washiyama Naoki, Hirano Masahiro, Ohashi Yuko, Yamanaka Ken, Takeuchi Yuki, Kishita Kenji, Shiiya Norihiko
First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Cardiovascular Surgery, NHO Hakodate Medical Center, Hokkaido, Japan.
JTCVS Tech. 2024 Sep 11;28:41-46. doi: 10.1016/j.xjtc.2024.08.021. eCollection 2024 Dec.
In the loop technique for mitral valve repair, the loop bundles are usually created during cardiac arrest after chordal length measurements, which seems time-consuming and less reproducible. To address this issue, we determined the loop length preoperatively using 4-dimensional computed tomography.
The loop length was determined on the basis of the distance from the papillary muscle head to the free margin of nonprolapsing leaflet corresponding to the prolapsed leaflet, to which the loops would be secured. Measurements were made on the commissural and long-axis views created by a medical image post-processor in the late systolic phase. This technique was used in consecutive 45 patients undergoing mitral valve repair with the loop technique since April 2021.
A total of 55 loop bundles were created in 45 patients; in 10 cases loop bundles were fixed to both anterior and posterior papillary muscles. There were 31 posterior, 6 anterior, and 8 bileaflet prolapse. The loop length was set at 16 to 26 mm (median 19 mm). Mitral valve repair was successfully completed in all patients, and the loop bundles of predetermined length were used successfully in 42 patients (93.3%). Postoperative echocardiography revealed none/trace regurgitation in 41 and mild regurgitation in 4. There was no hospital mortality or major postoperative complication. During 4 to 35 months follow-up (median 10 months), no case required reintervention for the mitral valve.
Preoperative measurements using 4-dimensional computed tomography can accurately and reproducibly predict the required loop length for mitral valve repair.
在二尖瓣修复的环路技术中，环路束通常在心脏停搏期间进行腱索长度测量后创建，这似乎耗时且重复性较差。为了解决这个问题，我们使用四维计算机断层扫描术前确定环路长度。
根据乳头肌头部到与脱垂瓣叶相对应的非脱垂瓣叶游离缘的距离确定环路长度，环路将固定于此。在收缩期末期由医学图像后处理程序创建的连合和长轴视图上进行测量。自2021年4月以来，该技术用于连续45例接受二尖瓣修复环路技术的患者。
45例患者共创建了55个环路束；10例中环路束固定于前后乳头肌。有31例后叶脱垂、6例前叶脱垂和8例双叶脱垂。环路长度设定为16至26毫米（中位数19毫米）。所有患者二尖瓣修复均成功完成，42例患者（93.3%）成功使用了预定长度的环路束。术后超声心动图显示41例无/微量反流，4例轻度反流。无医院死亡或重大术后并发症。在4至35个月的随访（中位数10个月）期间，无病例因二尖瓣需要再次干预。
使用四维计算机断层扫描进行术前测量可以准确且可重复地预测二尖瓣修复所需的环路长度。
