Shore D F, Gabbay S, Yellin E L, Frater R W
J Cardiovasc Surg (Torino). 1983 Mar-Apr;24(2):132-7.
Plastic repair of the mitral valve after rupture of the anterior chordae can only be performed when less that one third of the anterior leaflet has lost its chordal support. This experimental study was designed to examine a method for chordal replacement utilizing gluteraldehyde preserved pericardium (Bovine pericardium supplied by Hancock Laboratories). The correct length of the "new chorda" was determined by the use of anatomical rules. In applying these rules we adopted the hypothesis that the chordae were under tension throughout diastole. The anterior chordae were replaced in eight dogs. At the end of the procedure the valve was tested and found to be competent in every case. Two dogs died before restudy because of the development of bacterial endocarditis confirmed histologically. Five dogs were restudied four months to two years after chordal replacement. There was no evidence of mitral incompetence and the mean left atrial pressure was within the normal range in each of the five dogs restudied. Histological examination of the new chordae demonstrated both cartilage formation and calcification. Electron microscopy demonstrated excellent healing of both suture sites with ingrowth of native collagen fibres between the fibres of the preserved pericardium. We conclude that excellent haemodynamic results can be obtained after chordal replacement and are maintained in spite of degenerative changes. Early calcification is known to occur in biological materials implanted in dogs and the use of this technique in man will be determined by the specific biological environment.
仅当前叶不到三分之一失去腱索支持时，才能进行二尖瓣前叶腱索断裂后的整形修复。本实验研究旨在探讨一种利用戊二醛保存的心包（由汉考克实验室提供的牛心包）进行腱索置换的方法。“新腱索”的正确长度通过应用解剖学规则来确定。在应用这些规则时，我们采用了腱索在整个舒张期都处于张力状态的假设。对八只狗进行了前叶腱索置换。手术结束时对瓣膜进行测试，发现每例瓣膜功能均正常。两只狗在再次研究前因组织学确诊的细菌性心内膜炎死亡。五只狗在腱索置换后四个月至两年进行了再次研究。五只再次研究的狗均无二尖瓣关闭不全的证据，且平均左心房压力均在正常范围内。对新腱索的组织学检查显示有软骨形成和钙化。电子显微镜检查显示两个缝合部位愈合良好，天然胶原纤维长入保存的心包纤维之间。我们得出结论，腱索置换后可获得优异的血流动力学结果，且尽管有退行性改变仍能维持。已知植入狗体内的生物材料会早期发生钙化，该技术在人体中的应用将取决于特定的生物环境。
