Extensive use of polytetrafluoroethylene artificial grafts for prolapse of posterior mitral leaflet
Extensive use of polytetrafluoroethylene artificial grafts for prolapse of posterior mitral leaflet
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DOI：
10.1016/j.athoracsur.2004.03.036
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发表时间：
2004-09-01
影响因子：
4.6
通讯作者：
Tatewaki, H
中科院分区：
文献类型：
--
作者：
Tomita, Y;Yasui, H;Tatewaki, H
背景越来越多的报告涉及使用膨体聚四氟乙烯（e-PTFE）缝线重建腱索进行二尖瓣修复。然而，关于该技术在二尖瓣后叶脱垂中的广泛应用或结果的信息很少。1994年3月至2000年12月期间，22例因后瓣叶脱垂（年龄范围：39-73岁）而发生中度至重度二尖瓣返流（MR）的患者通过使用4-CV e-PTFE缝线重建人工腱索进行二尖瓣修复，未切除瓣叶。所有患者均行Kay缝合或瓣环成形术以纠正瓣环扩张。未观察到手术死亡或晚期死亡。出院前，术后即刻超声心动图显示22例患者中有20例二尖瓣返流低于中度。通过临床检查和系列超声心动图完成了所有病例的随访，中位随访期为87个月（范围24-108）。有2例因修复不成功和MR恶化（乳头肌锚定侧延长）而需要再次手术的失败。当从随访数据中排除再次手术患者时，通过最近随访期间进行的超声心动图估计的二尖瓣返流程度，6例患者不存在，10例患者轻微，4例患者轻度。左室收缩和舒张期内径均明显减小（P < 0.01）。人工腱索的置换并不复杂，并且似乎保留了瓣叶组织、腱索和乳头肌之间的良好关系。因此，我们认为，广泛使用PTFE人工腱索似乎是一种有前途的手术，用于修复导致MR的多种二尖瓣病变。（C）2004由胸外科医师协会。
Background. There are an increasing number of reports concerning mitral valve repair by means of reconstruction of the chordae tendinae with expanded polytetrafluoroethylene (e-PTFE) sutures. However little information is available about extended application or results of this technique for extended prolapse of posterior mitral leaflets.Methods. Between March 1994 and December 2000, 22 patients with moderate-to-severe mitral regurgitation (MR) as the result of a prolapse of posterior leaflets (age range, 39-73 years) underwent mitral valve repair by means of reconstruction of artificial chordae with 4-CV e-PTFE sutures without leaflet resection. Either Kay's suture or ring annuloplasty was also performed to correct annular dilatation in all patients.Results. No operative death or late mortality was observed. Before discharge immediate postoperative echocardiography indicated less than moderate MR in 20 out of 22 patients. The follow-up was complete in all cases by clinical examination and serial echocardiograms and the median follow-up period was 87 months (range 24-108). There were two failures that required reoperation because of unsuccessful repair and worsening MR (elongation of the anchored side of the papillary muscle). When the reoperated patients were excluded from the follow-up data, the degree of MR, estimated by echocardiography that was performed at a recent follow-up period, was nonexistent in 6 patients, trivial in 10 patients, and mild in 4 patients. The systolic and diastolic dimensions of the left ventricle decreased significantly (p < 0.01).Conclusions. Replacement of the artificial chordae was not complicated and seemed to preserve favorable relationships among leaflet tissues, chordae, and papillary muscles. We therefore suggest that the extensive use of PTFE artificial chordae seems to be a promising procedure regarding the repair of many kinds of mitral lesions causing MR. (C) 2004 by The Society of Thoracic Surgeons.