Comparison of artificial neochordae and native chordal transfer in the repair of a flail posterior mitral leaflet: an experimental study.
Comparison of artificial neochordae and native chordal transfer in the repair of a flail posterior mitral leaflet: an experimental study.
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DOI：
10.1016/j.athoracsur.2012.09.055
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发表时间：
2013-02
影响因子：
4.6
通讯作者：
Yoganathan, Ajit P.
中科院分区：
文献类型：
--
作者：
Padala, Muralidhar;Cardinau, Benedicte;Gyoneva, Lazarina I.;Thourani, Vinod H.;Yoganathan, Ajit P.
连枷后叶的手术重建是常规二尖瓣修复术，其技术已从瓣叶切除发展到瓣叶保留。人工ePTFE新腱索常用于稳定连枷瓣叶，很少将瓣膜的自体次级腱索移位至瓣叶自由边缘。在本研究中，我们试图研究两种技术矫正后叶脱垂和减少二尖瓣返流的有效性，并量化急性修复后瓣叶运动学。在搏动性左心实验模型中研究了成年猪二尖瓣（N =7），在该模型中，通过边缘腱索横断模拟孤立的P2连枷。在正常条件下（对照）确定每个瓣膜的基线条件，然后通过横断后叶游离缘上的两个边缘腱索诱导孤立的P2连枷（疾病）。使用人工新腱索（修复1）和自体腱索移位（修复2）重建连枷后叶。使用B型超声心动图或彩色多普勒测量瓣叶连枷的减少、二尖瓣返流分数的变化、瓣叶接合长度和后叶活动度。在基线时，所有瓣膜功能正常，无二尖瓣返流。后叶边缘腱索横断后，孤立性P2连枷明显，返流率为13.7±13%。人工新腱索重建消除了瓣叶连枷，并将二尖瓣返流降低至3.2± 2.8%，腱索移位纠正了瓣叶连枷，二尖瓣返流测量值为2.3± 2.6%。使用任何一种修复技术，修复瓣叶的瓣叶接合和活动度均充分，且与基线测量值相当。两种技术的瓣叶连枷和返流复位以及生理瓣叶对合恢复相当，表明在急性条件下，使用人工新腱索或自体腱索移位具有相似的受益。
Surgical reconstruction of a flail posterior leaflet is a routine mitral valve repair, the techniques for which have evolved from leaflet resection to leaflet preservation. Artificial ePTFE neochordae are frequently used to stabilize the flail leaflet, and seldom translocation of the native secondary chordae of the valve to the leaflet free edge is used. In this study, we sought to investigate the efficacy of the two techniques to correct posterior leaflet prolapse and reduce mitral regurgitation, and quantify the acute post-repair leaflet kinematics. Adult porcine mitral valves (N =7) were studied in a pulsatile left heart experimental model in which isolated P2 flail was mimicked by marginal chordal transection. Baseline conditions were established in each valve under normal conditions (control), and followed by induction of isolated P2 flail by transecting the two marginal chordae on the posterior leaflet free edge (disease). The flail posterior leaflet was reconstructed using artificial neochordae (repair 1) and then native chordal translocation (repair 2). Reduction in leaflet flail, changes in mitral regurgitation fraction, leaflet coaptation length, and posterior leaflet mobility were measured using B-mode echocardiography or color doppler. At baseline, all the valves were competent with no mitral regurgitation. After transection of the marginal chordae on the posterior leaflet, isolated P2 flail was evident with 13.7±13% regurgitation. Reconstruction with artificial neochordae eliminated leaflet flail and reduced mitral regurgitation to 3.2± 2.8%, and with chordal translocation leaflet flail was corrected and mitral regurgitation was measured at 2.3±2.6%. Using either repair techniques, leaflet coaptation and mobility of the repaired leaflets were adequate and comparable to the baseline measurements. Comparable reduction leaflet flail and regurgitation, and restoration of physiological leaflet coaptation with the two techniques indicates that under acute conditions, use of artificial neochordae or native chordal translocations have similar benefits.
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影响因子：
6
作者：
Padala, Muralidhar;Gyoneva, Lazarina;Yoganathan, Ajit P.
通讯作者：
Yoganathan, Ajit P.
影响因子：
4.6
作者：
Padala, Muralidhar;Cardinau, Benedicte;Gyoneva, Lazarina I.;Thourani, Vinod H.;Yoganathan, Ajit P.
通讯作者：
Yoganathan, Ajit P.
DOI：
10.1016/j.jmbbm.2012.03.016
发表时间：
2012-09-01
影响因子：
3.9
作者：
Casado, J. A.;Diego, S.;Gutierrez-Solana, F.
通讯作者：
Gutierrez-Solana, F.
影响因子：
6
作者：
Padala, Muralidhar;Powell, Scott N.;Croft, Laura R.;Thourani, Vinod H.;Yoganathan, Ajit P.;Adams, David H.
通讯作者：
Adams, David H.
影响因子：
4.6
作者：
Spencer, FC;Galloway, AC;Colvin, SB
通讯作者：
Colvin, SB