Roberts W C, Lachman A S
Am Heart J. 1979 Jul;98(1):56-62. doi: 10.1016/0002-8703(79)90320-x.
Among 164 patients who underwent mitral valve replacement because of mitral stenosis (with or without mitral regurgitation) and had radiographs taken of their operatively excised mitral valves, 20 had absent or minimal calcific deposits in the excised valves and absent or minimal mitral regurgitation as determined, except for one patient, by left ventricular angiography preoperatively. This report focuses on these 20 patients to ask if mitral valve replacement was preferable to mitral valve commissurotomy. Although in the pre-valve replacement era, all 20 patients almost surely would have been considered good candidates for mitral commissurotomy, other factors, namely, the need to replace one or more other cardiac valves (13 patients), the utilization of cardiopulmonary bypass allowing visual inspection rather than simple palpation of the diseased mitral valve (all 20 patients), relatively little experience with mitral commissurotomy in four of the five surgeons (17 patients), displeasure with attempted commissurotomy (three patients), previous mitral commissurotomy (11 patients), and incorrect identification of mitral calcific deposits (two patients), each contributed in one or more patients to the final decision of replacement versus commissurotomy. Even though mitral commissurotomy has been in use for 30 years, the mere alternative of valve replacement may have altered somewhat the definition of the stenotic mitral valve previously considered ideal for mitral commissurotomy.
在164例因二尖瓣狭窄（伴或不伴二尖瓣反流）而接受二尖瓣置换术且术中切除的二尖瓣有X光片的患者中，20例切除的瓣膜中钙化沉积缺失或极少，且除1例患者外，术前经左心室血管造影确定二尖瓣反流缺失或极少。本报告聚焦于这20例患者，探讨二尖瓣置换术是否优于二尖瓣交界切开术。尽管在瓣膜置换术前的时代，所有这20例患者几乎肯定会被认为是二尖瓣交界切开术的良好候选者，但其他因素，即需要置换一个或多个其他心脏瓣膜（13例患者）、使用体外循环以便能直视而非简单触诊病变的二尖瓣（所有20例患者）、五位外科医生中有四位对二尖瓣交界切开术经验相对较少（17例患者）、对尝试交界切开术不满意（3例患者）、既往有二尖瓣交界切开术史（11例患者）以及对二尖瓣钙化沉积识别错误（2例患者），在一个或多个患者中各自对最终选择置换术还是交界切开术起到了作用。尽管二尖瓣交界切开术已使用30年，但仅仅是瓣膜置换术这一替代选择可能已在一定程度上改变了先前被认为最适合二尖瓣交界切开术的狭窄二尖瓣的定义。
