DOUBLE-ORIFICE MITRAL-VALVE - A STUDY OF 27 POSTMORTEM CASES WITH DEVELOPMENTAL, DIAGNOSTIC AND SURGICAL CONSIDERATIONS
DOUBLE-ORIFICE MITRAL-VALVE - A STUDY OF 27 POSTMORTEM CASES WITH DEVELOPMENTAL, DIAGNOSTIC AND SURGICAL CONSIDERATIONS
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DOI：
10.1016/0002-9149(88)91322-7
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发表时间：
1988-01-01
影响因子：
2.8
通讯作者：
VANPRAAGH, R
中科院分区：
文献类型：
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作者：
BANORODRIGO, A;VANPRAAGH, S;VANPRAAGH, R
什么是双孔二尖瓣解剖学和胚胎学？27例死后均发现张量器异常。这些畸形可以概括为：(1)弦环；(2)副乳头肌；(3)肌脊细分；(4)融合乳头肌（降落伞二尖瓣值）；(5)跨腱索；(6)中心纤维细分。每个病例通常同时存在1个以上的这些异常。双孔二尖瓣几乎总是由基本正常的小叶上的异常孔组成，而不是正常小叶之间的异常纤维桥或粘连。由于较小的副瓣口和较大的主瓣口之间的纤维“桥”是由二尖瓣小叶组织和脊索组成的，而不是纤维粘连，因此这些桥不应通过手术横切，以避免医源性二尖瓣反流。11例（41%）的副孔位于前外侧连合处，12例（44%）的副孔位于后内侧连合处，4例（15%）的副孔位于中心纤维分支处，其大小大致相等。12例（44%）房室（AV）管正常分离，15例（56%）存在共同房室（AV）管。当副孔位于前外侧连合处时，房室管通常正常分离（8 / 11,73%）。但当副孔位于后内侧连合处时，几乎总是存在共同的房室管（12 / 12,92%）。功能上，二尖瓣正常13例（48%），反流7例（26%），狭窄7例（26%）。对双孔二尖瓣的诊断和手术理解的关键是下面的张量器。
What is double-orifice mitral valve anatomically and embryologically? In 27 postmortem cases, an anomaly of the tensor apparatus was always found. These malformations may be summarized as: (1) chordal ring; (2) accessory papillary muscle or muscles; (3) subdividing muscular ridge; (4) fused papillary muscles (parachute mitral value); (5) crossing chordae tendineae; and (6) central fibrous subdivision. More than 1 of these anomalies often coexisted per case. Double-orifice mitral valve almost always consisted of abnormal holes in essentially normal leaflets, rather than of abnormal fibrous bridges or adhesions between normal leaflets. Since these fibrous "bridges" between the smaller accessory orifice and the larger main orifice are composed of mitral leaflet tissue and chordae, not fibrous adhesions, these bridges should not be transected surgically, to avoid iatrogenic mitral regurgitation. The accessory (smaller) orifice was at the anterolateral commissure in 11 cases (41%), at the posteromedial commissure in 12 (44%) and there was a central fibrous subdivision with approximately equal-sized orifices in 4 (15%). The atrioventricular (AV) canal was normally divided in 12 cases (44%) and a common AV canal was present in 15 (56%). When the accessory orifice was at the anterolateral commissure, the AV canal usually was normally divided (8 of 11, 73%). But when the accessory orifice was at the posteromedial commissure, a common AV canal almost always was present (11 of 12, 92%). Functionally, the mitral valve was normal in 13 (48%), regurgitant in 7 (26%) and stenotic in 7 cases (26%). The key to the diagnostic and surgical understanding of the double-orifice mitral valve is the underlying tensor apparatus.