Okita Y, Miki S, Ueda Y, Tahata T, Sakai T, Matsuyama K
Department of Cardiovascular Surgery. Tenri Hospital, Nara, Japan.
J Thorac Cardiovasc Surg. 1994 Jul;108(1):42-51.
Postoperative left ventricular performance was evaluated in patients with mitral stenosis who underwent mitral valve replacement with maintenance of the continuity of the mitral anulus and papillary muscles. Mitral valve replacement with preservation of autologous chordae tendineae (n = 7) or their replacement with expanded polytetrafluoroethylene sutures (n = 14) was performed in 21 patients with mitral stenosis. Hemodynamic parameters were compared with those of 28 patients who underwent conventional mitral valve replacement and 27 patients who underwent open mitral valve commissurotomy. No deaths occurred in the early or late follow-up period. All hemodynamic parameters were improved after the operation, and no significant differences were detected among the three groups with regard to postoperative cardiac index or mitral valve area. No significant differences were observed in left ventricular end-diastolic volume index, end-systolic volume index, or contractility index, but the postoperative left ventricular ejection fraction in the chordal preservation and open commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative regional shortening was greatest at the diaphragmatic portion in the chordal preservation group and at the long axis in the open commissurotomy group. In the mid-term postoperative period, although no differences were noted among the three groups in echocardiographic data or global ejection fraction measured by multigated equilibrium radionuclide angiography, the regional shortening at the anterolateral portion of the left ventricle in the chordal preservation and commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative radionuclide angiography during exercise failed to demonstrate any difference between the ejection fraction in the chordal preservation group and that in the group having conventional mitral valve replacement.
对接受二尖瓣置换术并维持二尖瓣环和乳头肌连续性的二尖瓣狭窄患者的术后左心室功能进行了评估。21例二尖瓣狭窄患者接受了保留自体腱索（n = 7）或用膨体聚四氟乙烯缝线替代腱索（n = 14）的二尖瓣置换术。将血流动力学参数与28例接受传统二尖瓣置换术的患者和27例接受直视二尖瓣交界切开术的患者进行了比较。在早期或晚期随访期间均未发生死亡。术后所有血流动力学参数均得到改善，三组在术后心脏指数或二尖瓣面积方面未检测到显著差异。左心室舒张末期容积指数、收缩末期容积指数或收缩性指数未观察到显著差异，但腱索保留组和直视交界切开术组的术后左心室射血分数高于传统二尖瓣置换术组。术后节段性缩短在腱索保留组的膈面部分最大，在直视交界切开术组的长轴部分最大。在术后中期，尽管三组在超声心动图数据或多门控平衡放射性核素血管造影测量的整体射血分数方面未发现差异，但腱索保留组和交界切开术组左心室前外侧部分的节段性缩短大于传统二尖瓣置换术组。运动期间的术后放射性核素血管造影未能显示腱索保留组和传统二尖瓣置换术组之间的射血分数有任何差异。
