Maeta H, Imawaki S, Shiraishi Y, Arioka I, Tanaka S
First Department of Surgery, Kagawa Medical School, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Nov;41(11):2294-9.
Cardiac surgeons have hesitated to perform valvuloplasty for MR caused by elongated or ruptured chordae of the anterior leaflet (AL) of the mitral valve. We experienced three cases of successful chordal reconstruction (CR) to the AL last year. Two of them were due to elongation of all chordae tendineae to the AL. Four CRs, one chordal shortening, cleft closure and ring annuloplasty (AP) were performed in one case, and 8 CRs to the AL, two to the posterior leaflet, commissural closure and ring AP in another. In the third case 2 CRs combined with Reed's AP, closure of ASD and tricuspid AP were performed. The MR disappeared in one case and improved to grade I in others postoperatively. NYHA classes improved from class III or IV to I or II postoperatively. The MRs have not increased 6 to 12 months after the surgery. The CR with PTFE suture enabled to do the valvuloplasty for the chordal abnormalities of the AL without valve resection. This technique seems to be adequate for repairing a major prolapse of the AL caused by multiple chordal abnormalities.
心脏外科医生对于因二尖瓣前叶腱索延长或断裂所致的二尖瓣反流进行瓣膜成形术一直犹豫不决。去年我们成功实施了3例针对前叶的腱索重建术。其中2例是由于所有连接至前叶的腱索均发生延长。1例患者进行了4次腱索重建、1次腱索缩短、裂缺闭合及瓣环成形术，另一例患者进行了8次针对前叶的腱索重建、2次针对后叶的腱索重建、瓣叶连合处闭合及瓣环成形术。第3例患者进行了2次腱索重建联合Reed瓣环成形术、房间隔缺损闭合及三尖瓣瓣环成形术。术后1例患者的二尖瓣反流消失，其他患者的二尖瓣反流改善为I级。纽约心脏协会（NYHA）心功能分级术后从III级或IV级改善为I级或II级。术后6至12个月二尖瓣反流未加重。采用聚四氟乙烯缝线进行腱索重建能够在不切除瓣膜的情况下针对前叶腱索异常实施瓣膜成形术。该技术似乎足以修复由多条腱索异常导致的前叶严重脱垂。
