Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: quadrangular resection versus triangular resection versus neochordoplasty.
Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: quadrangular resection versus triangular resection versus neochordoplasty.
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DOI：
10.1016/j.jtcvs.2009.01.031
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发表时间：
2009-08
影响因子：
6
通讯作者：
Adams, David H.
中科院分区：
文献类型：
--
作者：
Padala, Muralidhar;Powell, Scott N.;Croft, Laura R.;Thourani, Vinod H.;Yoganathan, Ajit P.;Adams, David H.
急性腱索断裂导致的瓣叶脱垂是纤维弹性缺陷的一种表现，与脱垂节段的瓣叶变化极小相关。最大限度减少切除和保留瓣叶组织可能是最佳手术策略。我们通过比较当今实践中的切除术和非切除术来研究瓣叶保护概念的重要性。手术操作前，在体外心脏模拟器中评价了8枚猪二尖瓣。通过切断后缘腱索在这些瓣膜中产生二尖瓣返流，导致严重P2脱垂。在通过二尖瓣返流测量（mL/次）确认二尖瓣返流后，通过三种修复术纠正返流：聚四氟乙烯缝线的新腱索成形术（Gore-Tex; W. L.戈尔联合公司，弗拉格斯塔夫，亚利桑那州），三角形切除术和四边形切除术与环形压缩。在二尖瓣峰值压力为120 mm Hg、心输出量为5 L/min（70次/min）的脉动条件下，对修复后瓣膜血流动力学进行定量。此外，还测量了血流动力学、几何学和超声心动图指数。横断边缘腱索导致严重P2脱垂和显著二尖瓣复流（19.3 ± 4.3 mL/次）。三种手术入路中的任何一种后，返流量均显著减少（四边形，4.38 ± 1.6 mL/次;三角形，2.56 ± 1.0 mL/次;新腱索，2.86 ± 1.24 mL/次）。与基线正常瓣膜相比，四边形切除组的瓣叶对合长度和后瓣叶活动度显著降低，而三角形切除组的瓣叶对合长度和后瓣叶活动度部分恢复，新腱索成形术组的瓣叶对合长度和后瓣叶活动度完全保留。尽管三种修复术在血流动力学方面具有可比性，但在该实验性急性腱索断裂模型中，瓣叶几何结构正常的情况下，非切除或有限切除矫正瓣叶脱垂后，瓣膜功能和瓣叶运动学明显更好。
Leaflet prolapse resulting from acute chordal rupture is one presentation of fibroelastic deficiency that is associated with minimal leaflet changes in the prolapsing segment. Minimizing resection and preserving leaflet tissue may be an optimal surgical strategy. We examined the importance of the leaflet preservation concept by comparing resective and nonresective surgical procedures in practice today. Eight porcine mitral valves were evaluated in an in vitro heart simulator before surgical manipulation. Mitral regurgitation was created in these valves by transecting the posterior marginal chordae resulting in severe P2 prolapse. After confirmation of mitral regurgiation via regurgitant flow measurement (mL/beat), regurgitation was corrected by three repairs: neochordoplasty with polytetrafluoroethylene sutures (Gore-Tex; W. L. Gore & Associates, Inc, Flagstaff, Ariz), triangular resection, and quadrangular resection with annular compression. Post-repair valve hemodynamics were quantified under pulsatile conditions of 120 mm Hg peak transmitral pressure and 5 L/min cardiac output at 70 beats/min. Furthermore, hemodynamic, geometric, and echocardiographic indices were measured. Transecting the marginal chordae resulted in severe P2 prolapse and significant mitral regurgiation (19.3 ± 4.3 mL/beat). Regurgitant volume was significantly reduced after any of the three surgical approaches (quadrangular, 4.38 ± 1.6 mL/beat; triangular, 2.56 ± 1.0 mL/beat; neochordal, 2.86 ± 1.24 mL/beat). In comparison with the baseline normal valves, leaflet coaptation length and posterior leaflet mobility were significantly reduced in the quadrangular resection group, whereas they were partially restored in the triangular resection and fully preserved in the neochordoplasty group. Although the three repair procedures are hemodynamically comparable, valve function and leaflet kinematics were significantly better after a nonresection or limited resective correction of leaflet prolapse in this experimental model of acute chordal rupture with otherwise normal leaflet geometry.
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影响因子：
37.8
作者：
Magne, Julien;Pibarot, Philippe;Senechal, Mario
通讯作者：
Senechal, Mario
DOI：
10.1016/j.jtcvs.2007.06.040
发表时间：
2008-02-01
影响因子：
6
作者：
Flameng, Willem;Meuris, Bart;Herregods, Marie-Christine
通讯作者：
Herregods, Marie-Christine
DOI：
10.1016/s0022-5223(98)00450-4
发表时间：
1998-11-01
影响因子：
6
作者：
Gillinov, AM;Cosgrove, DM;Loop, FD
通讯作者：
Loop, FD
影响因子：
4.6
作者：
Gazoni, Leo M.;Fedoruk, Lynn M.;Kron, Irving L.
通讯作者：
Kron, Irving L.
影响因子：
37.8
作者：
He, SQ;Fontaine, AA;Levine, RA
通讯作者：
Levine, RA