Bernal J M, Rabasa J M, Olalla J J, Carrión M F, Alonso A, Revuelta J M
Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain.
J Thorac Cardiovasc Surg. 1996 Jan;111(1):211-7. doi: 10.1016/S0022-5223(96)70418-X.
Sixty-two patients with rheumatic mitral valve disease (mean age 42.2 +/- 10.2 years) underwent repair of chordae tendineae between June 1974 and May 1994. Chordal shortening was done in 38 patients, fenestration in 17, resection of secondary chordae in 3, replacement in 2, and transposition in 2. In 41 patients, mitral commissurotomy was also done. Ring annuloplasty was done in all patients. The mean follow-up was 10.2 years (range 2 months to 20 years). The completeness of follow-up during the closing interval (January to July 1994) was 100%. Hospital mortality occurred in four patients (6.5%) and nine patients died during the late follow-up. The actuarial survival curve at 20 years was 65.8% +/- 10%. Six patients with mitral valve dysfunction (restenosis 4, insufficiency 2) and one with aortic valve dysfunction (structural deterioration of bioprosthesis) underwent reoperation. The actuarial curve of freedom from reoperation at 20 years for mitral valve dysfunction was 73.1% +/- 10.5%. In the 49 surviving patients, a Doppler echographic study during the closing interval showed a mean mitral valve area of 1.9 +/- 0.3 cm2. In the 43 patients with a repaired native valve, absent or trivial mitral regurgitation was documented in 35 and mild or moderate regurgitation in 8. In conclusion, repair of chordae tendineae in rheumatic mitral valve disease when feasible is a stable and safe procedure with a low prevalence of reoperation. However, the type of reconstructive operation and experience of the surgical team are major considerations in successful repair of the mitral valve.
1974年6月至1994年5月期间，62例风湿性二尖瓣疾病患者（平均年龄42.2±10.2岁）接受了腱索修复术。38例行腱索缩短术，17例行开窗术，3例行继发腱索切除术，2例行置换术，2例行移位术。41例患者同时行了二尖瓣交界切开术。所有患者均行瓣环成形术。平均随访时间为10.2年（范围2个月至20年）。在随访截止期（1994年1月至7月）随访的完整性为100%。4例患者发生医院死亡（6.5%），9例患者在后期随访中死亡。20年的精算生存曲线为65.8%±10%。6例二尖瓣功能障碍患者（4例再狭窄，2例关闭不全）和1例主动脉瓣功能障碍患者（生物瓣膜结构恶化）接受了再次手术。二尖瓣功能障碍20年无再次手术的精算曲线为73.1%±10.5%。在49例存活患者中，随访截止期的多普勒超声心动图研究显示二尖瓣平均瓣口面积为1.9±0.3cm²。在43例修复了天然瓣膜的患者中，35例记录为无或微量二尖瓣反流，8例为轻度或中度反流。总之，风湿性二尖瓣疾病可行时腱索修复术是一种稳定、安全的手术，再次手术发生率低。然而，重建手术的类型和手术团队的经验是二尖瓣成功修复的主要考虑因素。
