Nataf P, Pavie A, Jault F, Bors V, Cabrol C, Gandjbakhch I
Department of Thoracic and Cardiovascular Surgery, Hôpital de la Pitié, Paris, France.
Ann Thorac Surg. 1994 Jul;58(1):163-7. doi: 10.1016/0003-4975(94)91092-8.
Infectious lesions and extreme calcification of the mitral valve annulus can make classic anatomic implantation of a prosthesis impossible. Confronted with these circumstances, we have developed a technique of intraatrial insertion of a mitral prosthesis. The prosthesis has been modified by enlarging the circumference of the sewing ring with a Dacron collar. The collar can be sutured to the left atrial wall above the mitral annulus. From 1981 to 1989, this technique has been employed in 36 patients: 15 had acute valve endocarditis with destruction of the mitral annulus and 21 had extensive annular calcification. In all cases, circumferential or partial intraatrial insertion permitted a secure implantation of the prosthesis. One operative death was related to the technique. It was an intractable bleeding caused by tearing of the very thin and fragile wall of the left atrium in a kidney transplant patient. Four patients were reoperated on for periprosthetic leak, in 3 of whom healing and cleaning of the mitral annulus permitted annular implantation of a prosthetic valve. There was no ventricular wall rupture. Our results suggest that the technique can be performed in high operative risk patients when mitral valve replacement is impossible by conventional techniques.
感染性病变和二尖瓣环的极度钙化会使人工瓣膜的经典解剖植入无法实现。面对这些情况，我们开发了一种二尖瓣人工瓣膜心房内植入技术。通过用涤纶环扩大缝合环的周长对人工瓣膜进行了改良。该环可缝合至二尖瓣环上方的左心房壁。1981年至1989年，该技术应用于36例患者：15例患有急性瓣膜性心内膜炎且二尖瓣环破坏，21例有广泛的瓣环钙化。在所有病例中，环形或部分心房内植入使人工瓣膜得以安全植入。1例手术死亡与该技术相关。这是一名肾移植患者因左心房壁非常薄且脆弱撕裂导致的难治性出血。4例患者因人工瓣膜周漏再次手术，其中3例通过二尖瓣环的愈合和清理得以进行人工瓣膜的瓣环植入。未发生心室壁破裂。我们的结果表明，当传统技术无法进行二尖瓣置换时，该技术可用于手术风险高的患者。
