Yamanishi H, Izumoto H, Kitahara H, Kamata J, Tasai K, Kawazoe K
Third Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan.
Ann Thorac Cardiovasc Surg. 1998 Apr;4(2):83-6.
Mitral regurgitation secondary to ischemic heart disease carries a significant mortality even after emergency open heart surgery. From 1993 to 1997, four patients were operated on for ischemic mitral regurgitation secondary to papillary muscle rupture. These patients were between 58 and 69 years of age and all were in class III or IV of the New York Heart Association Classification. The responsible infarction area was located in the lateral wall in 2 patients, and inferior in others. The interval between the onset of acute myocardial infarction and the appearance of mitral regurgitation was from 1 to 10 days. Three patients had partial rupture (defined as only one or several heads of papillary muscle ruptured), and one had total papillary muscle rupture. Primary mitral plasty was performed in 3 patients, including 1 patient who had undergone patch closure of ventricular septal perforation at the onset of acute myocardial infarction. Mitral plasty combined with coronary artery bypass grafting was performed in 1 patient. Only one case, who had total papillary muscle rupture, required reoperation for recurrence of mitral regurgitation. We suggest that even in the case of ischemic mitral regurgitation, when a papillary muscle rupture is partial, mitral repair is performed because of its potential for improving therapeutic results.
缺血性心脏病继发的二尖瓣反流即使在急诊心脏直视手术后也有很高的死亡率。1993年至1997年，有4例因乳头肌破裂继发缺血性二尖瓣反流而接受手术治疗。这些患者年龄在58至69岁之间，均为纽约心脏协会心功能分级III级或IV级。2例患者梗死责任区位于侧壁，其他患者梗死责任区位于下壁。急性心肌梗死发作至二尖瓣反流出现的间隔时间为1至10天。3例患者为部分破裂（定义为仅一根或数根乳头肌破裂），1例为乳头肌完全破裂。3例患者行一期二尖瓣成形术，其中1例在急性心肌梗死发作时已行室间隔穿孔补片修补术。1例患者行二尖瓣成形术联合冠状动脉旁路移植术。仅1例乳头肌完全破裂的患者因二尖瓣反流复发需要再次手术。我们认为，即使对于缺血性二尖瓣反流，当乳头肌为部分破裂时，行二尖瓣修复术仍有可能改善治疗效果。
