Okita Y, Miki S, Ueda Y, Tahata T, Ogino H, Sakai T, Morioka K, Matsubayashi K, Nomoto T
Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
J Heart Valve Dis. 1997 Jan;6(1):37-42.
Although many studies have found that preservation of the continuity between the mitral annulus and the papillary muscles during mitral valve replacement improves postoperative left ventricular performance in patients with mitral regurgitation, much less research has been done in this respect in patients with mitral stenosis. We reviewed our experience with mitral valve replacement combined with chordae tendineae replacement in 29 patients with mitral disease, 26 of whom had mitral stenosis.
During mitral valve replacement, continuity between the papillary muscle and annulus was restored with expanded polytetrafluoroethylene (ePTFE) mattress sutures, which were threaded into the compact portion of each papillary muscle and placed at the 2, 4, 8 and 10 o'clock positions in the mitral annulus. Postoperatively, the patients were followed by echocardiographic assessment and exercise (stress) radionuclide angiography testing. The stress test results were compared with those in patients who had undergone traditional mitral valve replacement, and also those in normal people.
There were no hospital deaths, complications, or cardiac deaths or events during a median follow up of two-and-a-half years. Echocardiography showed no postoperative cardiac dilatation. The stress tests found no significant differences between the ejection fraction in mitral stenosis patients who underwent conventional mitral valve replacement and in those who had valve replacement combined with ePTFE chordae tendineae replacement.
A direct advantage of chordae-preserving mitral valve replacement over conventional replacement with respect to postoperative global left ventricular performance in patients with mitral valve stenosis has not been demonstrated. However, postoperative regional left ventricular contraction in patients with mitral stenosis has been observed to be better among those who have undergone the chordae-preserving procedure. Additional investigations are needed to elucidate the effects of this procedure in mitral stenosis, but we believe that the technique improves left ventricular performance and may decrease the risk of left ventricular rupture.
尽管许多研究发现，二尖瓣置换术中保留二尖瓣环与乳头肌之间的连续性可改善二尖瓣反流患者术后的左心室功能，但在二尖瓣狭窄患者中，这方面的研究较少。我们回顾了29例二尖瓣疾病患者行二尖瓣置换联合腱索置换的经验，其中26例为二尖瓣狭窄患者。
在二尖瓣置换术中，使用膨体聚四氟乙烯（ePTFE）褥式缝线恢复乳头肌与瓣环之间的连续性，将缝线穿入每个乳头肌的致密部分，并置于二尖瓣环的2点、4点、8点和10点位置。术后，通过超声心动图评估和运动（负荷）放射性核素血管造影检查对患者进行随访。将负荷试验结果与接受传统二尖瓣置换术的患者以及正常人的结果进行比较。
在中位随访两年半期间，无医院死亡、并发症、心脏死亡或事件发生。超声心动图显示术后无心脏扩大。负荷试验发现，接受传统二尖瓣置换术的二尖瓣狭窄患者与接受二尖瓣置换联合ePTFE腱索置换的患者之间，射血分数无显著差异。
在二尖瓣狭窄患者中，保留腱索的二尖瓣置换术相对于传统置换术在术后整体左心室功能方面的直接优势尚未得到证实。然而，观察到接受保留腱索手术的二尖瓣狭窄患者术后局部左心室收缩情况更好。需要进一步研究以阐明该手术在二尖瓣狭窄中的作用，但我们认为该技术可改善左心室功能，并可能降低左心室破裂的风险。
