Liu Chang, He Peiling, Song Yi, Wu Wenjun, Hu Yijie
Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China.
Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 29;40(4). doi: 10.1093/icvts/ivaf094.
To develop a decision-making framework for the surgical management of coexisting mitral valve (MV) prolapse and pectus excavatum, addressing the challenges posed by anatomical complexity and functional compromise.
A narrative review of reported cases involving coexisting MV prolapse and pectus excavatum was conducted. Each case was analysed to evaluate the characteristics, personalized surgical strategies and operational details, with a focus on the associated benefits and risks. Additionally, surgical strategies were classified, and process management approaches were explored to guide treatment planning.
The management of coexisting MV prolapse and pectus excavatum was categorized into three tailored approaches: (i) isolated chest wall reconstruction for cardiac decompression in patients with preserved valvular function; (ii) standalone MV repair or replacement for severe regurgitation with mild-to-moderate skeletal deformity (Haller index <3.5) and (iii) single-stage combined procedures for complex presentations (Haller index ≥3.5). A framework for personalized treatment pathways was proposed, incorporating factors such as deformity severity, surgical history and haemodynamic status to optimize approach selection.
The integration of innovative surgical techniques and minimally invasive approaches offers the potential for safe and effective outcomes. A personalized, anatomically stratified approach is essential for optimizing treatment strategies in patients with this complex comorbidity.
建立一个针对二尖瓣脱垂合并漏斗胸手术治疗的决策框架，以应对解剖结构复杂和功能受损带来的挑战。
对已报道的二尖瓣脱垂合并漏斗胸病例进行叙述性综述。分析每个病例的特征、个性化手术策略及手术细节，重点关注相关的获益和风险。此外，对手术策略进行分类，并探索流程管理方法以指导治疗规划。
二尖瓣脱垂合并漏斗胸的治疗分为三种定制方法：（i）对于瓣膜功能良好的患者，采用单纯胸壁重建以实现心脏减压；（ii）对于伴有轻度至中度骨骼畸形（Haller指数<3.5）的严重反流患者，单独进行二尖瓣修复或置换；（iii）对于复杂情况（Haller指数≥3.5），采用一期联合手术。提出了个性化治疗路径框架，纳入畸形严重程度、手术史和血流动力学状态等因素以优化治疗方法选择。
创新手术技术与微创方法的结合为实现安全有效的治疗结果提供了可能。对于患有这种复杂合并症的患者，采用个性化、解剖分层的方法对于优化治疗策略至关重要。
