Hvass U, Chatel D, Caliani J, Oroudji M
Hôpital Bichat, F-Paris, France.
Eur J Cardiothorac Surg. 1996;10(10):874-8. doi: 10.1016/s1010-7940(96)80314-9.
Some mitral lesions are still out of reach of conventional repairs. Transferring the posterior leaflet of the tricuspid valve with its subvalvular apparatus to the mitral valve is a new autograft technique which has allowed us a conservative approach in cases where repair seemed less predictable.
After removing the posterior tricuspid leaflet with its subvalvular apparatus, the tricuspid autograft was inserted by implanting its papillary muscle onto the mitral papillary muscle and then by suturing the leaflet tissue in place. The tricuspid valve was subsequently repaired by annular plication and leaflet suture. A tricuspid ring was used in all but the first case.
The age of the seven patients ranged from 20 to 70 years. Postoperative controls by transesophageal echocardiography showed no leaks in five and trivial in one on the site of the mitral repair. On the tricuspid valve, we found a moderate leak in the first case and trivial or none in the following cases, where a tricuspid ring was used. With a 3-12 month follow-up the results are stable.
This autograft technique is reproducible, and extends the field of mitral valve repairs. Compared to segments of mitral homografts, we prefer the intraoperative availability of natural chordae and valvular leaflet that have no immunological interference. The patient is his own tissue bank and the tricuspid valve can be repaired with a very low risk of significant dysfunction.
一些二尖瓣病变仍无法通过传统修复方法解决。将三尖瓣后叶及其瓣下装置转移至二尖瓣是一种新的自体移植技术，该技术使我们在修复效果难以预测的病例中能够采取保守治疗方法。
切除三尖瓣后叶及其瓣下装置后，将三尖瓣自体移植物植入，方法是将其乳头肌植入二尖瓣乳头肌，然后将瓣叶组织缝合到位。随后通过环缩和瓣叶缝合修复三尖瓣。除第一例外，所有病例均使用了三尖瓣环。
7例患者年龄在20至70岁之间。经食管超声心动图术后检查显示，二尖瓣修复部位5例无渗漏，1例有微量渗漏。在三尖瓣方面，我们发现第一例有中度渗漏，在使用三尖瓣环的后续病例中有微量渗漏或无渗漏。随访3至12个月，结果稳定。
这种自体移植技术具有可重复性，扩展了二尖瓣修复的领域。与二尖瓣同种异体移植物节段相比，我们更倾向于术中可获得无免疫干扰的天然腱索和瓣膜瓣叶。患者自身就是组织库，修复三尖瓣后出现严重功能障碍的风险非常低。
