Kasegawa H, Furusawa T, Okada Y, Asakawa E, Tsukuda K, Yamada K, Kikuchi K, Mannouji E, Ida T, Kawase M
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Kyobu Geka. 1995 Jul;48(8):638-41.
Between July 1991 and January 1995, 74 patients with pure mitral valve regurgitation (MR) underwent mitral valve plasty (MVP) at out institute. Our procedure includes chordal replacement of the anterior leaflet with PTFE sutures (42 patients). There were one hospital death (1.4%) and two late deaths (2.7%) in this series. Only 2 patients (2.7%) needed valve replacement after unsatisfactory repair during the same operation. Late postoperative doppler echocardiographic study (mean follow-up, 12.0 months) showed less than mild regurgitation in 66 patients (95.7%) of 69 patients who are alive. In April 1993 we decided to complete the repair with no or only trivial regurgitant flow by intraoperative transesophageal echodoppler study (TEE). The results have remarkably improved. Late postoperative echodoppler study revealed less than mild reguritant flow in all 49 patients having undergone mitral valve repair with no or trivial regurgitation by intraoperative TEE. It is clear than the TEE study has contributed to the better quality of mitral valve plasty, and we believe that it is important for better long term results to complete mitral valve plasty with no or only trivial regurgitant flow.
1991年7月至1995年1月期间，我院对74例单纯二尖瓣反流（MR）患者施行了二尖瓣成形术（MVP）。我们的手术方法包括用聚四氟乙烯缝线对前叶进行腱索置换（42例患者）。本系列中有1例医院死亡（1.4%）和2例晚期死亡（2.7%）。在同一手术中，只有2例患者（2.7%）在修复效果不满意后需要进行瓣膜置换。术后晚期多普勒超声心动图研究（平均随访12.0个月）显示，在69例存活患者中，有66例（95.7%）反流程度小于轻度。1993年4月，我们决定通过术中经食管超声多普勒研究（TEE）实现无反流或仅有微量反流的修复。结果有了显著改善。术后晚期超声多普勒研究显示，在所有49例经术中TEE检查无反流或仅有微量反流而接受二尖瓣修复的患者中，反流程度均小于轻度。显然，TEE研究有助于提高二尖瓣成形术的质量，我们认为实现无反流或仅有微量反流的二尖瓣成形术对于获得更好的长期效果很重要。
