Gometza B, al-Halees Z, Shahid M, Hatle L K, Duran C M
Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
J Heart Valve Dis. 1996 May;5(3):294-301.
Mitral valve repair is less stable in rheumatic than in degenerative disease. This failure rate is inversely related to the age of the patient. Based on our clinical experience, we selected the group of patients with the worst results for this study: (i) rheumatic, (ii) age 20 or under, (iii) pure mitral regurgitation (MR), and, (iv) no aortic disease.
Between 1988 and 1995, 83 consecutive patients complied with these characteristics. No patient was excluded. Replacement (MVR) was performed in 26 and repair (MRp) in 57 (69%).
There was one hospital death (1%) with an actuarial survival at 48 months of 74.8% +/- 19% for MVR and of 97.9% +/- 2.1% at 78 months for MRp. There were no thromboembolic events. Reoperation was required in one MVR (4%) and in 21 MRp (37%), within same admission in six, within three months in eight, under one year in three, and beyond in four cases. Severe MR appeared in five further cases. No statistical difference was found between the preoperative clinical data, operative findings and surgical maneuvers of those patients with successful and unsuccessful repair. The rate of failure was similar after Kay (14/29) and Duran (12/28) annuloplasty. All patients showed a rapid decrease in left ventricular dimensions. Early failures showed elongation of previously shortened chordae at reoperation, together with more reduction in systolic dimension than the other groups. Late failures were more related to progression of the rheumatic process. No clear relationship between rheumatic activity and failure rate was found.
Rheumatic mitral regurgitation in the young remains a serious problem. The treatment of this frequent pathology in the developing countries needs a new approach based on the knowledge that it starts at the annulus. Earlier surgery at this level might prevent its further progression, avoiding the problems of secondary chordal elongation.
风湿性二尖瓣修复术的稳定性低于退行性疾病。这种失败率与患者年龄呈负相关。基于我们的临床经验，我们选择了该研究中结果最差的患者群体：（i）风湿性，（ii）年龄20岁及以下，（iii）单纯二尖瓣反流（MR），以及（iv）无主动脉疾病。
1988年至1995年间，连续83例患者符合这些特征。无患者被排除。26例行置换术（MVR），57例行修复术（MRp，占69%）。
有1例医院死亡（1%），MVR组48个月的精算生存率为74.8%±19%，MRp组78个月的精算生存率为97.9%±2.1%。无血栓栓塞事件。1例MVR患者（4%）和21例MRp患者（37%）需要再次手术，其中6例在同一住院期间，8例在三个月内，3例在一年内，4例在一年后。另有5例出现严重MR。成功修复和未成功修复患者的术前临床数据、手术发现和手术操作之间未发现统计学差异。Kay（14/29）和Duran（12/28）瓣环成形术后的失败率相似。所有患者左心室尺寸均迅速减小。早期失败病例在再次手术时显示先前缩短的腱索延长，收缩期尺寸的减小比其他组更多。晚期失败更多与风湿性病变的进展有关。未发现风湿活动与失败率之间有明确关系。
年轻患者的风湿性二尖瓣反流仍然是一个严重问题。在发展中国家，这种常见疾病的治疗需要一种基于从瓣环开始这一认识的新方法。在此水平更早进行手术可能会阻止其进一步发展，避免继发性腱索延长的问题。
