Adebo O A, Ross J K
Thorac Cardiovasc Surg. 1984 Jun;32(3):139-42. doi: 10.1055/s-2007-1023370.
Sixty-five patients were treated for ruptured mitral valve chordae from January, 1976, to December, 1981; 21 patients underwent valve reconstruction (group A) and 44 underwent valve replacement (group B). Both groups had a mean age of 62 years with an overall male: female ratio of 2:1. Eighty-one percent of group A and 73% of group B presented in clinical class III/IV (NYHA). Chordal rupture was spontaneous in 76% (group A) and 61% (group B) respectively, with posterior leaflet chordal involvement in most patients. The operative mortality was 6.8% (3 deaths) in group B with no early death in group A (p less than 0.001). More than 85% of both groups were in class I/II (NYHA) postoperatively. The actuarial survival at 5 years was 85% in group A and 78% in group B. No emboli occurred in group A while an actuarial incidence of freedom from emboli of 76% at 5 years was observed in group B (p less than 0.046). One patient (4.8%) in group A was reoperated for failed valve repair. The patients with repaired valves were assessed by echocardiography. The peak rates of dimension change of the left ventricular cavity were in the normal range in all but 3 patients, while the left ventricular and end-diastolic dimensions were significantly reduced (p less than 0.005). We conclude that valve reconstruction provides an improved functional result in patients with ruptured mitral chordae in addition to an increased event-free survival.
1976年1月至1981年12月期间，65例患者因二尖瓣腱索断裂接受治疗；21例患者接受瓣膜重建（A组），44例接受瓣膜置换（B组）。两组患者的平均年龄均为62岁，总体男女比例为2:1。A组81%和B组73%的患者临床表现为纽约心脏协会（NYHA）心功能Ⅲ/Ⅳ级。A组和B组腱索断裂分别有76%和61%为自发性，大多数患者后叶腱索受累。B组手术死亡率为6.8%（3例死亡），A组无早期死亡（p<0.001）。两组术后超过85%的患者为NYHA心功能Ⅰ/Ⅱ级。A组5年精算生存率为85%，B组为78%。A组未发生栓塞，而B组5年无栓塞精算发生率为76%（p<0.046）。A组1例患者（4.8%）因瓣膜修复失败再次手术。对接受瓣膜修复的患者进行了超声心动图评估。除3例患者外，所有患者左心室腔内径变化的峰值速率均在正常范围内，而左心室舒张末期内径显著减小（p<0.005）。我们得出结论，瓣膜重建除了能提高无事件生存率外，还能改善二尖瓣腱索断裂患者的功能结果。
