Repair of anterior mitral leaflet prolapse using artificial Gore-Tex loops in preoperatively echo-determined length

Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse,especially for anterior leaflets.Here we introduce our experiences of using echo-determined normal chordael length to make the loops preoperatively and rebuild the elongated / ruptured chordae intraoperatively.Materials and method From June 2011 to February 2012,19 consecutive cases with mitral anterior leaflet prolapse underwent valve repair procedures.Echocardiography was used to determine the length of normal chordae that the prolapsed leaflets should have for normal coaptation.The artificial chordae was fabricated in loops according to echo-determined length.Results All patients survived the operations.2.8 preoperatively prepared loops were used per patient to restore the anterior leaflets,as well as posterior leaflets.Artificial mitral valve rings were applied to 18 patients for mitral annuloplasty.16 patients were underwent different concomitant operations.Echocardiographic results at discharge showed that grade of mitral regurgitation,left ventricular end-diastolic,end-systolic dimension decreased definitely,respectively from 3.26 ± 1.10,53.79 ± 15.03 mm,33.00 ± 12.05 mm preoperatively to 0.47 ± 0.61(P < 0.01),44.74 ± 10.28 mm(P < 0.01),30.16 ± 10.58 mm(P < 0.05)postoperatively.All patients improved clinically and NYHA functional class decreased significantly from 2.17 ± 0.81 to 1.12 ± 0.33.Conclusion Reconstruction of prolapsed anterior leaflet chordae with artificial loops in preoperatively echo-determined length is safe and effective,and initial clinical outcome is satisfactory.     

全胸腔镜微创主动脉瓣及双瓣置换术的早期结果

目的 总结全胸腔镜微创主动脉瓣置换（aortic valve replacement,AVR）及双瓣置换（double valve replacement,DVR）的早期结果。方法 回顾性分析2020年4月—2021年1月于广东省人民医院全胸腔镜下行AVR和DVR患者的临床资料。根据手术方式将患者分为AVR组和DVR组，比较两组患者临床资料。结果 纳入患者22例，其中男14例、女8例，平均年龄（50.0±11.2）岁。退行性病变8例，风湿性心脏病联合瓣膜病8例，二叶式主动脉瓣6例。AVR组16例，DVR组6例。所有患者均顺利完成手术，无死亡病例，术中出现瓣周漏2例。体外循环和主动脉阻断时间分别为（187.0±39.9）min和117.0(99.0,158.0)min，术后机械通气和ICU停留时间分别为9.5(4.8,18.3)h和41.0(34.0,64.0)h，术后24 h胸腔引流量（214.0±124.6）mL，术后住院时间5.5(4.0,8.3)d。DVR组体外循环时间、主动脉阻断时间比AVR组长，术后24 h胸腔引流量比AVR组多，且差异具有统计学意义（P<0.05）。平...     

Early variation of left ventricular dimension and mitral regurgitation after correction for anomalous origin of the left coronary artery from the pulmonary artery

Background Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital cardiac lesion resulting in myocardial ischemia even infarction,morphological impairment and dysfunction of left ventricle,together with mitral regurgitation.Here we will introduce our experience in the surgical repair of this kind of congenital lesion and the retrospective analysis about the improvement of left ventricular dimension and mitral regurgitation in early postoperative term.Method From May 1998 to July 2012,38 consecutive patients with anomalous coronary artery from the pulmonary artery underwent surgical correction(33 received left coronary artery re-implantation,4 left coronary artery ligation or primary closure,1 Takeuchi procedure,and 10 simultaneous mitral valve plasty).Left ventricular dimension,mitral regurgitation,and ejection fraction,were measured by color Doppler echocardiography preoperatively,and 1 month after discharge.Results Hospital survival was 94.7%(2 in-hospital deaths).Ten paptients with more than moderate mitral regurgitation received simultaneous mitral plasty,one of whom was converted to mechanical prosthetic valve replacement.Mitral valve annuloplasty was applied in 9 cases of coronary re-implantation correction,3 of whom also received additional mitral leaflet cleft repair.Meanwhile 8 patients underwent other different concomitant operations.Echocardiographic results for the survivals 1 month after discharge showed that left ventricular end-diastolic,endsystolic dimension decreased from 40.05 ± 5.56 mm and 28.94 ± 6.21 mm to 33.07 ± 6.82 mm(P < 0.01) and 23.04 ± 5.87 mm(P < 0.01) respectively.The average mitral regurgitation grade was also reduced from 2.36 ± 1.08 to 1.64 ± 93(P < 0.05) in the group.All survival patients improved clinically and NYHA functional class decreased significantly from 2.37 ± 1.08 to 2.10 ± 0.54(P < 0.05).Conclusions The surgical repair of anomalous origin of the left coronary artery from the pulmonary artery is safe and effective,and can get satisfactory dimensional and functional improvement of the left ventricle in early term.Although controversial,concomitant mitral valve plasty can be helpful for critical patients with severe mitral regurgitation.