Hvass U, Juliard J M, Assayag P, Laperche T, Pansard Y, Chatel D
Cardiovascular Surgery and Department of Cardiology, Hôpital Bichat, Paris 75018, France.
Lancet. 1996 Mar 9;347(9002):659-61. doi: 10.1016/s0140-6736(96)91206-4.
Transferring the posterior leaflet of the patient's own tricuspid valve with its subvalvular apparatus to the mitral valve is a new technique that allows a conservative approach to mitral-valve repair. The technique is based on the knowledge that the tricuspid valve can be remodelled from tricuspid to bicuspid, with a very low risk of significant dysfunction.
We describe six patients (age range 20-70 years) with mitral insufficiency in whom we have used the technique.
All patients survived the operation and were in sinus rhythm. Transoesophageal echocardiography before discharge showed trivial or no regurgitation at the site of mitral repair. Before operation, all patients were in New York Heart Association class III-IV; at follow-up after 6-13 months all patients were in class I-II.
Compared with using segments of mitral homografts in similar situations, the intraoperative availability of the tricuspid's viable natural chordae and valvular leaflet means that there are no immunological disadvantages to the procedure. With this new operation, the patient is his own tissue bank.
将患者自身三尖瓣后叶及其瓣下结构转移至二尖瓣是一种新的技术，可采用保守方法进行二尖瓣修复。该技术基于这样的认识，即三尖瓣可从三尖瓣重塑为二尖瓣，且严重功能障碍风险极低。
我们描述了6例（年龄范围20 - 70岁）二尖瓣关闭不全患者，我们对其使用了该技术。
所有患者均存活，且为窦性心律。出院前经食管超声心动图显示二尖瓣修复部位仅有微量反流或无反流。术前，所有患者纽约心脏协会心功能分级为III - IV级；6 - 13个月随访时，所有患者分级为I - II级。
与在类似情况下使用二尖瓣同种异体移植物节段相比，三尖瓣有活力的天然腱索和瓣膜小叶在术中的可用性意味着该手术无免疫方面的劣势。通过这种新手术，患者自身就是组织库。
