Cohn L H, Allred E N, Cohn L A, Disesa V J, Shemin R J, Collins J J
Am J Cardiol. 1985 Mar 1;55(6):731-4. doi: 10.1016/0002-9149(85)90146-8.
Open mitral reconstruction for rheumatic mitral stenosis (MS) was performed in 120 patients, 101 women and 19 men, aged 22 to 75 years (mean 49). Nine patients were functional class II, 106 class III, 5 class IV; 13 only underwent noninvasive studies, including echocardiography, before surgery, while 107 had preoperative cardiac catheterization studies. The latter showed a mean valve area of 1.09 cm2 and a pulmonary artery wedge to left ventricular mean diastolic gradient of 14 mm Hg. Cardiopulmonary bypass was used in all patients for open reconstruction under direct vision. Superior commissurotomy was done in 115 patients, inferior in 114, papillary muscles were incised and chordae lengthened in 39 and calcium was excised from valve leaflets in 23. Suture or ring anuloplasty was not required in any patient. The series was begun January 1972 and terminated in January 1984. Personal follow up was conducted in July 1984. There were no operative deaths in the 120 patients. There were 5 late deaths, all from noncardiac causes. The mean follow-up time was 53 months. The actuarial probability of survival at 10 years was 95 +/- 2%. Thromboemboli occurred in 9 patients; the probability of freedom from thromboemboli at 10 years was 91 +/- 3% and the linearized rate was 1.8%/patient-year of follow-up. Reoperation was required in 9 patients, an absolute incidence of 7.5% and an annual incidence of 1.7%/patient year. At 10 years the probability of freedom from reoperation was 84 +/- 5%.
对120例风湿性二尖瓣狭窄（MS）患者实施了开放式二尖瓣重建手术，其中女性101例，男性19例，年龄22至75岁（平均49岁）。9例患者心功能为Ⅱ级，106例为Ⅲ级，5例为Ⅳ级；13例患者术前仅接受了包括超声心动图在内的非侵入性检查，107例患者术前进行了心导管检查。后者显示平均瓣膜面积为1.09平方厘米，肺动脉楔压与左心室平均舒张压梯度为14毫米汞柱。所有患者均在直视下进行开放式重建手术时使用了体外循环。115例患者进行了上瓣交界切开术，114例进行了下瓣交界切开术，39例切开乳头肌并延长腱索，23例从瓣膜小叶上切除钙化灶。所有患者均无需进行缝线或环缩成形术。该系列研究始于1972年1月，止于1984年1月。1984年7月进行了个人随访。120例患者中无手术死亡病例。有5例晚期死亡，均为非心脏原因。平均随访时间为53个月。10年的精算生存率为95±2%。9例患者发生血栓栓塞；10年无血栓栓塞的概率为91±3%，线性化发生率为1.8%/患者年随访时间。9例患者需要再次手术，绝对发生率为7.5%，年发生率为1.7%/患者年。10年无需再次手术的概率为84±5%。
