Mechanism of Recurrent/Persistent Ischemic/Functional mitral regurgitation in the chronic phase after surgical annuloplasty - Importance of augmented posterior leaflet tethering
Mechanism of Recurrent/Persistent Ischemic/Functional mitral regurgitation in the chronic phase after surgical annuloplasty - Importance of augmented posterior leaflet tethering
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DOI：
10.1161/circulationaha.105.000729
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发表时间：
2006-07-04
期刊：
影响因子：
37.8
通讯作者：
Tei, Chuwa
中科院分区：
文献类型：
--
作者：
Kuwahara, Eiji;Otsuji, Yutaka;Tei, Chuwa
背景-外科瓣环成形术可能会使后瓣环向前抬高，加重后叶(PML)拴系，并导致复发的缺血性/功能性二尖瓣反流(MR)。方法与结果：应用超声心动图测量30例缺血性心脏瓣膜成形术患者和20例正常对照患者手术前、术后早期和术后晚期的肺前叶(AML)和PML与环连线的夹角、吻合部的后移和尖端移位以及MR分级。术后早期MR和AML的拴系分级普遍降低(P<；0.01)，而PML的拴系显著恶化(P<；0.01)。30例患者中有9例术后晚期出现复发/持续性MR表现。与没有晚期MR的患者相比，与早期相比，有MR的患者表现出类似的环状面积减少，接合后移位显著增加，以及术后晚期PML栓系的进行性恶化(P<；0.05)。在单变量分析中，术前MR和术后晚期MR均与所有系留变量显著相关。虽然根尖结合的移位是术前MR的主要决定因素(r(2)=0.6，P<；0.0001)，但增加的PML栓系是晚期MR的主要决定因素(r(2)=0.75，P<；0.0001)。结论：虽然两个叶的拴系与术前的缺血性MR有关，但两个叶的拴系的主要作用是增强和进行性的PML拴系与术后晚期复发/持续的缺血/功能性MR有关。
Background - Surgical annuloplasty can potentially hoist the posterior annulus anteriorly, exaggerate posterior leaflet (PML) tethering, and lead to recurrent ischemic/functional mitral regurgitation (MR). Characteristics of leaflet configurations in late postoperative MR were investigated.Methods and Results - In 30 patients with surgical annuloplasty for ischemic MR and 20 controls, the anterior leaflet (AML) and PML tethering angles relative to the line connecting annuli, posterior and apical displacement of the coaptation and the MR grade were measured by echocardiography before, early after, and late after surgery. Early after surgery, grade of MR and AML tethering generally decreased (P < 0.01), whereas PML tethering significantly worsened (P < 0.01). Nine of the 30 patients showed recurrent/ persistent MR late after surgery. Compared with patients without late MR, those with the MR showed similar reduction in the annular area, significant re- increase in posterior displacement of the coaptation, and progressive worsening in PML tethering (P < 0.05) late after surgery in comparison to the early phase. Both preoperative MR and late postoperative MR were significantly correlated with all tethering variables in univariate analysis. Although apical displacement of the coaptation was the primary determinant of preoperative MR (r(2) = 0.60, P < 0.0001), increased PML tethering was the primary determinant of late MR (r(2) = 0.75, P < 0.0001).Conclusions - Whereas both leaflets tethering is related to preoperative ischemic MR, both leaflets tethering but with predominant contribution from augmented and progressive PML tethering is related to recurrent/ persistent ischemic/ functional MR late after surgical annuloplasty.