Hvass U, Chatel D, Assayag P, Juliard J M, Laperche T, Caliani J, Oroudji M, Pansard Y
Service de chirurgie cardiaque, hôpital Bichat, Paris.
Arch Mal Coeur Vaiss. 1996 Feb;89(2):249-52.
Mitral valve repair was performed in six patients by transferring the posterior tricuspid leaflet with its sub-valvular apparatus onto the mitral valve. This new technique considers the tricuspid valve as the patients own tissue bank where the posterior leaflet and eventually the adjacent part of the anterior leaflet is used as a "donor" valve, based on the knowledge that the right atrio-ventricular valve can be efficiently repaired with a very low risk of significant dysfunction. The mitral repair consists of incorporating the tricuspid autograft by securing the tricuspid papillary muscle to the mitral papillary muscle and by suturing the leaflet tissue where required. A mitral annuloplasty ring reinforces the repair. The tricuspid valve is subsequently repaired by annular plication and leaflet suture. A tricuspid ring is necessary to maintain efficient remodeling. The six patients ages ranged from 20 to 70 years. A etiology, was rheumatic in the first case and degenerative in the following. In three cases, sterilised endocarditis was responsible for ruptured chordae and leaflet destruction. The mitral insufficiency was located in a commissural area in 4 cases, and was due to a widespread posterior prolapse in 2. Post-operative control transesophageal echocardiography confirmed the excellent results of the repair and proved that, in selected cases, the tricuspid leaflet inserted onto the mitral apparatus is very efficient in correcting mitral insufficiency, without causing significant tricuspid impairment. With a 3 to 7 month follow-up, the results are stable.
对6例患者进行了二尖瓣修复，方法是将后三尖瓣叶及其瓣下结构转移至二尖瓣上。这项新技术将三尖瓣视为患者自身的组织库，基于右房室瓣能够以极低的严重功能障碍风险得到有效修复这一认识，以后叶乃至前叶的相邻部分作为“供体”瓣膜。二尖瓣修复包括通过将三尖瓣乳头肌固定于二尖瓣乳头肌并在必要时缝合瓣叶组织来纳入三尖瓣自体移植物。二尖瓣成形环加强修复。随后通过瓣环折叠和瓣叶缝合修复三尖瓣。需要一个三尖瓣环来维持有效的重塑。6例患者年龄在20至70岁之间。病因方面，第一例为风湿性，其余为退行性。3例中，无菌性心内膜炎导致腱索断裂和瓣叶破坏。二尖瓣关闭不全4例位于交界区，2例由于广泛的后叶脱垂。术后经食管超声心动图检查证实修复效果极佳，并证明在选定病例中，植入二尖瓣装置的三尖瓣叶在纠正二尖瓣关闭不全方面非常有效，且不会造成明显的三尖瓣损害。随访3至7个月，结果稳定。
