Okita Y, Miki S, Ueda Y, Tahata T, Sakai T, Matsuyama K
Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
Ann Thorac Surg. 1995 Jan;59(1):187-9. doi: 10.1016/0003-4975(94)00797-B.
The mitral valve was replaced with a collar-reinforced prosthetic valve in 6 patients with a disrupted mitral annulus, in 3 because of infective endocarditis, including 2 patients with prosthetic valve endocarditis, in 2 because of a severely calcified mitral annulus, and in 1 who had previously undergone mitral valve replacement twice. Four patients had undergone prior mitral operations; these consisted of mitral valve replacement in 3 patients and mitral valve repair in 1. In all patients, the prosthesis was secured by double-layered sutures, with the first row of buttressed sutures passing through the leaflet or sutured to the left ventricular muscle and through the sewing cuff of the prosthetic valve. The second row of running sutures was then placed through an extended annular equine pericardial cuff of the prosthetic valve and the supraannular left atrial wall. In 2 patients, all chordae tendineae were preserved to maintain annulopapillary muscle continuity. All patients survived and have remained well for a mean of 22.3 months. There has been no prosthetic valve dehiscence, except for minimal paraprosthetic leakage in 1 patient. These results demonstrate that mitral valve replacement in patients with a disrupted mitral annulus can be successfully accomplished with a collar-reinforced prosthetic valve.
6例二尖瓣环破裂患者接受了带环加强人工瓣膜置换术，其中3例因感染性心内膜炎，包括2例人工瓣膜心内膜炎，2例因二尖瓣环严重钙化，1例曾两次接受二尖瓣置换术。4例患者曾接受过二尖瓣手术；其中3例为二尖瓣置换术，1例为二尖瓣修复术。所有患者均采用双层缝线固定人工瓣膜，第一排支撑缝线穿过瓣叶或缝合至左心室心肌并穿过人工瓣膜的缝合环。然后将第二排连续缝线穿过人工瓣膜的扩大环形马心包袖口和瓣上左心房壁。2例患者保留了所有腱索以维持瓣环乳头肌连续性。所有患者均存活，平均随访22.3个月情况良好。除1例患者有轻微人工瓣膜旁漏外，未发生人工瓣膜裂开。这些结果表明，带环加强人工瓣膜可成功完成二尖瓣环破裂患者的二尖瓣置换术。
