Special Mitral Valve Issue.
Special Mitral Valve Issue.
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特殊二尖瓣问题。
DOI：
10.1007/s13239-015-0222-1
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发表时间：
2015
影响因子：
1.8
通讯作者：
Kunzelman,KarynS
中科院分区：
文献类型：
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作者：
Kunzelman,KarynS
从达芬奇开始，二尖瓣的结构和功能引起了解剖学家、内科医生、外科医生、科学家和工程师的极大兴趣。然而，对正常二尖瓣的复杂机械功能以及天然瓣膜组织在健康和疾病中的生物学行为的完整了解仍然难以实现。然而，特别是近年来，已经取得了很大进展。本期 CVET 特刊介绍了一些最新的科学研究，这些研究涉及正常功能、疾病或破坏引起的变化以及修复和更换的手术方法。最初，解决二尖瓣疾病的手术方法是从 20 世纪 60 年代初开始的“简单”瓣膜置换术，即去除原生瓣膜结构并缝入人工瓣膜。第一个商用瓣膜是球笼式设计、倾斜盘和双叶瓣膜，这些瓣膜在解剖学上都与原生二尖瓣结构相似。尽管设计改进带来了优越的血流动力学，但研究表明，简单地更换瓣叶的打开/关闭功能而不保留瓣膜下装置会导致结果不理想。 1983 年，卡彭蒂埃发表了具有里程碑意义的文章“法国矫正”，改变了外科领域的格局。他提出了新的外科修复技术，目的是使瓣膜恢复到正常的解剖学状态，从而恢复功能状态，而无需更换。八十年代，Carpentier、Duran、Frater 和 David 的持续工作令人信服地证明了二尖瓣修复的优越性。现在，在许多中心，执业外科医生可以对 90% 以上的病例进行二尖瓣修复术。
Beginning with Da Vinci, the structure and function of the mitral valve have been of great interest to anatomists, physicians, surgeons, scientists, and engineers. Yet, a complete understanding of the complex mechanical function of the normal mitral valve, as well as the biological behavior of the native valve tissue in both health and disease remains elusive. However, much progress has been made, particularly in recent years. This special issue of CVET presents some of the latest scientific studies that address normal function, changes due to disease or disruption, and surgical approaches for repair and replacement. Initially, the surgical approach to address mitral valve disease was ‘‘simple’’valve replacement beginning in the early 1960s, in which the native valve structures were removed, and a prosthetic valve sewn in. The first commercially available valves were ball and cage designs, tilting disk, and bi-leaflet valves, none of which are anatomically similar to the native mitral structure. Even though design improvements led to superior hemodynamics, it was shown that simply replacing the open/close function of the leaflets, without preservation of the subvalvular apparatus, led to suboptimal results.Dr. Carpentier changed the surgical landscape in 1983 with his publication of the landmark article ‘‘the French Correction’’. He presented new surgical repair techniques, with the goal of returning the valve to a normal anatomical, and thus functional, state without the need for replacement. During the eighties, continuing work by Carpentier, Duran, Frater, and David convincingly demonstrated the superiority of mitral valve repair. Now, practicing surgeons can perform mitral repair in more than 90% of cases in many centers.