“缘对缘”技术基础上的腱索转移法治疗二尖瓣前叶脱垂

目的 介绍一种操作简单、效果可靠的矫治二尖瓣前叶脱垂的手术方法.方法 2004年1月至2010年10月,应用“缘对缘”技术基础上的腱索转移法治疗二尖瓣前叶脱垂病例共18例,先行脱垂部位前叶与相应部位后叶的“缘对缘”缝合,矩形切下缝合处的后叶,连同相应的腱索、乳头肌,转移至前叶.再行后叶成形,完成瓣膜成形手术.所有患者出院前和半年后随访时再次行超声心动图检查.结果 手术无死亡病例,1例因术后第3天出现二尖瓣前叶穿孔再次行二尖瓣置换手术,血红蛋白尿1例,低心排血量综合征1例,给予对症处理,其余15例患者均顺利康复出院.术后远期随访无死亡,心功能全部恢复至Ⅰ级.复查超声心动图二尖瓣瓣口面积2.8～4.8(3.78±0.52) cm2,均无明显反流,反流面积(0.45±0.22) cm,左房径术前(48.26±11.12) mm,术后(37.57±9.56) mm(P＝ 0.028);左室舒张末径术前(61.43±8.24) mm,术后(42.35±10.79) mm(P＝0.008).结论 “缘对缘”技术基础上的腱索转移法治疗二尖瓣前叶脱垂,操作简单,可以取得良好的成形效果.

Repair for the prolapse of the anterior mitral valve leaflet with chordal transfer based on the "edge-to-edge" technique

Objective To introduce a kind of operative technique in repair for the prolapse of the anterior mitral valve leaflet.Methods From January 2004 to October 2010,the operation of chordal transfer based on the"edge-to-edge" technique was performed in 18 cases with serious mitral valve regurgitation because of prolapse of the anterior leaflet.First,the "edge-to-edge" suturing was performed at the free edge of the prolapsed anterior leaflet with corresponding posterior leaflet.After that,quadrangular resection was performed to transfer these segments of posterior leaflet with its attached chordae.At last,the posterior leaflet was repaired after a quadrangular resection which would be much easier for the surgeons.After the operation,echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived after the operation,1 case required the rnitral valve replacement because of anterior leaflet performation occurring 3 days after the operation,1 case with hemoglobinuria and 1 case with low cardiac output,who all got symptomatic treatment afterwards.All the other patients were well discharged.At the time of follow-up,all of the patients were in NYHA functional class I.In all these patients,pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve:the cross-sectional area of the mitral valve was 2.8-4.8 (3.78 +0.52) cm2,the mean regurgitation area was (0.45 +0.22) cm２.At the same time,both dimension of left atrium and left ventricular reduced significantly left atrium diameter:pre-operation ( 48.26 + 11.12 ) mm,post-operation ( 37.57 ± 9.56) mm (P ＝ 0.028 );the end-diastolic diameter of the left ventricular:pre-operation(61.43 ± 8.24) mm,post-operation (42.35 ±10.79) mm (P＝0.008)].Conclusion Chordal transfer based on the "edge-to-edge" technique provides good results for repair of anterior leaflet prolapse.