Caves P K, Paneth M
Thorax. 1973 Mar;28(2):158-68. doi: 10.1136/thx.28.2.158.
Thirty-seven patients with non-rheumatic subvalvar mitral regurgitation are reported, representing 16% of all patients with mitral regurgitation submitted to open operation over a five-and-a-half-year period. In 22 older patients with `idiopathic' chordal lesions, the commonest finding was rupture of chordae to the posterior leaflet. The aortic leaflet chordae were most frequently involved following myocardial infarction (7 patients) or bacterial endocarditis (3 patients). Three other younger patients had ruptured chordae and two patients had rupture of the posteromedial papillary muscle following acute myocardial infarction. The mitral valve was repaired in 16 patients with ruptured chordae, of whom only eight obtained a satisfactory late result. In the other 21 patients the valve was replaced with a mounted aortic homograft or a Starr-Edwards prosthesis. It is concluded that mitral valve repair should be reserved for patients with symmetrical rupture of the chordae controlling the centre of the posterior leaflet, as regurgitation may reappear after other forms of repair due to progressive rupture of other abnormal chordae or breakdown of the repair. The early and late mortality in the patients with a definite antecedent myocardial infarction was much higher than in the other groups, and emergency valve replacement soon after rupture of the papillary muscle was unsuccessful in both patients.
本文报告了37例非风湿性二尖瓣瓣下反流患者，占五年半期间接受二尖瓣反流开放手术患者总数的16%。在22例患有“特发性”腱索病变的老年患者中，最常见的发现是后叶腱索断裂。主动脉瓣叶腱索在心肌梗死（7例）或细菌性心内膜炎（3例）后最常受累。另外3例年轻患者腱索断裂，2例患者在急性心肌梗死后出现后内侧乳头肌断裂。16例腱索断裂患者进行了二尖瓣修复，其中只有8例获得了满意的远期效果。在其他21例患者中，瓣膜被置换为带支架的主动脉同种异体移植物或Starr-Edwards人工瓣膜。结论是二尖瓣修复应仅用于控制后叶中心的腱索对称断裂的患者，因为其他形式的修复后可能会因其他异常腱索的渐进性断裂或修复失败而再次出现反流。有明确心肌梗死病史的患者的早期和晚期死亡率远高于其他组，并且在乳头肌断裂后不久进行的紧急瓣膜置换在两名患者中均未成功。
