Akiba T, Becker A E, Neirotti R, Tatsuno K
Department of Cardiovascular Pathology, University of Amsterdam, Academic Medical Center, The Netherlands.
Ann Thorac Surg. 1993 Aug;56(2):295-9. doi: 10.1016/0003-4975(93)91163-h.
The remodeling of the atrioventricular valves in patients with complete atrioventricular septal defects is the crucial part of surgical repair. Variability in valve morphology is an important factor. This study evaluates the variability in morphology of the anterior and posterior leaflets in 30 heart specimens. All hearts had an anterior bridging leaflet: Rastelli type A in 12, type B in 2, and type C in 16. The posterior leaflet revealed four morphologic patterns: a right- and left-sided posterior leaflet, both inserting directly onto the crest of the ventricular septum (5 hearts); a common posterior leaflet attached to the septal crest by a membrane (2 hearts); a common posterior leaflet attached to the septal crest by multiple chordae (13 hearts); and a virtually free-floating posterior leaflet (11 hearts). The categorization is surgically relevant in making a distinction between hearts with and without an interventricular communication underneath the posterior leaflet. Surgically relevant variations occurred also in arrangement and positioning of chordae originating from the right septal side. There was no relationship between the Rastelli classification of the anterior leaflet and that of the posterior leaflet. The variability in morphology of the posterior leaflet and its attachments to the ventricular septum appear equally crucial for successful repair as that of the anterior leaflet.
完全性房室间隔缺损患者房室瓣的重塑是手术修复的关键部分。瓣膜形态的变异性是一个重要因素。本研究评估了30个心脏标本中前后叶形态的变异性。所有心脏均有一个前桥瓣：Rastelli A型12个，B型2个，C型16个。后叶呈现四种形态模式：右侧和左侧后叶，均直接附着于室间隔嵴（5个心脏）；一个共同的后叶通过膜附着于间隔嵴（2个心脏）；一个共同的后叶通过多条腱索附着于间隔嵴（13个心脏）；以及一个几乎游离的后叶（11个心脏）。这种分类在区分后叶下方有无室间隔交通的心脏方面具有手术相关性。起源于右间隔侧的腱索的排列和定位也出现了具有手术相关性的变异。前叶的Rastelli分类与后叶的分类之间没有关系。后叶形态及其与室间隔的附着的变异性对于成功修复似乎与前叶同样关键。
