Vander Salm T J, Pape L A, Mauser J F
Division of Thoracic and Cardiac Surgery, University of Massachusetts Medical School, Worcester.
Ann Thorac Surg. 1995 Jan;59(1):52-5. doi: 10.1016/0003-4975(94)00612-B.
Although both mitral leaflets contribute equally to the preservation of left ventricular function after mitral valve replacement, most surgeons routinely excise the anterior mitral leaflet. Possible disadvantages of leaflet retention are left ventricular outflow tract obstruction and interference with prosthetic valve motion. In 31 patients undergoing mitral valve replacement, all mitral valvular and subvalvular tissue was completely retained using a technique that involved reefing the native leaflets into the valve sutures. Fifteen Carpentier-Edwards porcine and 16 St. Jude Medical valves were implanted. Two patients died of causes unrelated to this technique. In the others, echocardiography demonstrated either no or an insignificant left ventricular outflow tract gradient, and, in most, no valvular tissue could be seen in the left ventricular outflow tract. No interference with prosthetic leaflet mobility occurred. The salutary results of mitral valve replacement with complete leaflet retention recommend its use.
尽管二尖瓣置换术后两个瓣叶对左心室功能的维持作用相同，但大多数外科医生常规切除二尖瓣前叶。保留瓣叶可能存在的缺点是左心室流出道梗阻和对人工瓣膜活动的干扰。在31例接受二尖瓣置换术的患者中，采用一种将天然瓣叶折叠入瓣膜缝线的技术，完全保留了所有二尖瓣及瓣下组织。植入了15个Carpentier-Edwards猪心包瓣膜和16个圣犹达医疗公司的瓣膜。2例患者死于与该技术无关的原因。在其他患者中，超声心动图显示左心室流出道压差无或不显著，并且在大多数患者中，左心室流出道未见瓣膜组织。未发生对人工瓣叶活动的干扰。完全保留瓣叶进行二尖瓣置换术的良好结果值得推广应用。
