Ohtaki E, Kasegawa H, Asano R, Tobaru T, Misu K, Kitahara K, Umemura J, Sumiyoshi T, Kawase M, Saito K
Department of Cardiology, Sakakibara Heart Institute, Tokyo.
J Cardiol. 1998;31 Suppl 1:61-5; discussion 66.
Preoperative echocardiography provides good planning information for successful repair of mitral valve regurgitation, but identifying the prolapse of both the anterior and posterior leaflets is sometimes difficult. To clarify the cause of this problem, preoperative echocardiographic findings and intraoperative observations of the prolapse were analyzed in 124 patients with non-rheumatic pure mitral regurgitation. In 48 patients with final diagnoses of bileaflet prolapse, 16 (33%) were considered to have only single leaflet prolapse before the operation. Anterior leaflet prolapse was overlooked in 14, and prolapse of either of its commissural segments was the least detectable by echocardiography. Chordal rupture was seen more in the posterior leaflet than in the anterior leaflet. Movement of the anterior leaflet may be influenced by a prolapsed and hypermobile posterior leaflet and/or regurgitant jet flow caused by the posterior leaflet prolapse.
术前超声心动图可为二尖瓣反流的成功修复提供良好的规划信息，但有时难以识别前叶和后叶的脱垂。为了阐明这个问题的原因，我们对124例非风湿性单纯二尖瓣反流患者的术前超声心动图结果和术中脱垂观察进行了分析。在最终诊断为双叶脱垂的48例患者中，16例（33%）在手术前被认为只有单叶脱垂。14例前叶脱垂被漏诊，其任一交界段的脱垂最不易被超声心动图检测到。腱索断裂在后叶比前叶更常见。前叶的运动可能受到脱垂且活动过度的后叶和/或后叶脱垂引起的反流束的影响。
