Grossi E A, Steinberg B M, LeBoutillier M, Ribacove G, Spencer F C, Galloway A C, Colvin S B
Department of Surgery, New York University Medical Center, NY 10016.
Circulation. 1994 Nov;90(5 Pt 2):II195-7.
With the widespread application of mitral valve reconstructive techniques, systolic anterior motion (SAM) of the anterior mitral leaflet causing left ventricular outflow tract obstruction has been recognized by several groups. SAM occurred in 9.1% of the first 441 patients operated on for mitral valve reconstruction at our institution. Fortunately, SAM subsided with medical therapy within 1 year for a majority of patients as reported in May 1993. Some surgeons, however, have considered abandoning repair for prosthetic replacement after SAM was detected on intraoperative echocardiogram.
Since June 1991, a triangular anterior leaflet resection has been cautiously evaluated in patients with extensive anterior leaflet tissue. This has been performed in 23 of 119 patients.
The frequency of SAM in the 119 study patients has decreased from 9.1% to 3.4%.
随着二尖瓣重建技术的广泛应用，几组研究均已认识到二尖瓣前叶收缩期向前运动（SAM）可导致左心室流出道梗阻。在我们机构接受二尖瓣重建手术的前441例患者中，SAM的发生率为9.1%。幸运的是，正如1993年5月所报道的，大多数患者经药物治疗后SAM在1年内消退。然而，一些外科医生在术中超声心动图检测到SAM后，考虑放弃修复而进行人工瓣膜置换。
自1991年6月起，我们对有广泛前叶组织的患者谨慎评估了三角形前叶切除术。119例患者中有23例接受了该手术。
119例研究患者中SAM的发生率从9.1%降至3.4%。
