Suzuki K, Nakano M, Miyazawa S, Mashiko K, Hashimoto K, Okuyama H, Arai T, Kurosawa H
Department of Cardiovascular Surgery, Jikei University of Medicine, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Jan;41(1):27-31.
Twenty-three patients underwent repair of a partial atrioventricular canal defect and have been followed for a mean of 9.4 years. The patients were divided into two groups according to the management of mitral cleft. Mitral cleft was not repaired in seven patients and directly sutured or repaired by valvuloplasty using pericardium in sixteen patients. In seven patients untreated mitral cleft left, two patients have required mitral valve replacement because of progressive severe mitral regurgitation. In sixteen patients mitral cleft repaired, no patients have required re-operation. However, one patient using pericardium in valvuloplasty, mitral regurgitation was in progress recently due to calcification and degeneration of the pericardium. The peak flow velocity, pressure gradient, pressure half time, and valve area in the mitral valve were measured by echo-doppler study. We recognized no statistical difference among two groups about hemodynamic performance in the mitral valve.
23例患者接受了部分房室通道缺损修复术，并进行了平均9.4年的随访。根据二尖瓣裂的处理方式将患者分为两组。7例患者未修复二尖瓣裂，16例患者直接缝合或采用心包瓣膜成形术修复二尖瓣裂。在未治疗二尖瓣裂的7例患者中，2例因进行性严重二尖瓣反流而需要二尖瓣置换术。在16例修复二尖瓣裂的患者中，无患者需要再次手术。然而，1例采用心包瓣膜成形术的患者，由于心包钙化和退变，近期二尖瓣反流仍在进展。通过超声多普勒研究测量二尖瓣的峰值流速、压力阶差、压力减半时间和瓣口面积。我们发现两组二尖瓣血流动力学表现无统计学差异。
1）关于术后二尖瓣反流，应修复二尖瓣裂。2）二尖瓣裂闭合后，二尖瓣血流模式未受干扰。3）自体心包不适用于瓣膜成形术，因为心包钙化和退变可能导致二尖瓣进行性关闭不全。
