Mechanism of Recurrent/Persistent Ischemic/Functional Mitral Regurgitation Following Surgical Annuloplasty : Importance of Augmented Posterior Leaflet Tethering

瓣环成形术后复发/持续性缺血/功能性二尖瓣反流的机制：增强后叶系留的重要性

• 批准号: 17500334
• 负责人: OTSUJI Yutaka
• 金额: $ 2.24万
• 依托单位: University of Occupational and Environmental Health, Japan (2006)Kagoshima University (2005)
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2005
• 资助国家: 日本
• 起止时间: 2005 至 2006
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-17500334/
• 关键词: ischemic mitral regurgitation; surgical annuloplasty

Surgical annuloplasty can potentially hoist the posterior annulus anteriorly, exaggerate posterior leaflet (PML) tethering, and lead to recurrent ischemic/functional mitral regurgitation (MR). 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), while PML tethering significantly worsened (p<0.01). Nine of the 30 patients showed recurrent/persistent MR late after surgery. Compared to 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. While apical displacement of the coaptation was the primary determinant of pre-operative MR (r^2=0.60, p<0.0001), increased PM., tethering was the primary determinant of late MR (r^2=0.75, p<0.0001). 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.

外科瓣环成形术可能会将后瓣环向前提升，扩大后瓣叶（PML）栓系，并导致复发性缺血性/功能性二尖瓣返流（MR）。在30例缺血性二尖瓣返流的外科瓣环成形术患者和20例对照患者中，通过超声心动图测量了前叶（AML）和PML相对于瓣环连接线的栓系角、接合的后部和顶端位移以及二尖瓣返流等级。术后早期，MR和AML栓系分级普遍降低（p<0.01），而PML栓系显著恶化（p<0.01）。30例患者中有9例在术后晚期出现复发性/持续性二尖瓣返流。与未发生晚期MR的患者相比，发生MR的患者术后晚期与早期相比，瓣环面积减少相似，接合后移位再次显著增加，PML栓系进行性恶化（p<0.05）。虽然接合的顶端位移是术前MR的主要决定因素（r^2=0.60，p<0.0001），但PM增加，栓系是晚期MR的主要决定因素（r^2=0.75，p<0.0001）。两个瓣叶系留，但主要来自增强和进行性PML系留，与手术瓣环成形术后晚期复发性/持续性缺血性/功能性MR相关。

项目成果

Mechanism of persistent ischemic mitral regurgitation after annuloplasty : importance of augmented posterior mitral leaflet tethering.

瓣环成形术后持续缺血性二尖瓣反流的机制：增强二尖瓣后叶栓系的重要性。

• 发表时间: 2005
• 期刊: Circulation 112(suppl 1)
• 作者: Zhu F;Otsuji Y;Yotsumoto G;Yuasa T;Ueno T;Yu B;Koriyama C;Hamasaki S;Biro S;Kisanuki A;Minagoe S;Levine RA;Sakata R;Tei C
• 通讯作者: Tei C

Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in the chronic phase

慢性期反复/持续性缺血/功能性二尖瓣反流的机制

• 期刊: Circulation 114[suppl I]
• 作者: Kuwahara E;Otsuji Y;et al.
• 通讯作者: et al.

Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in the chronic phase after surgical annuloplasty

瓣环成形术后慢性期复发/持续缺血/功能性二尖瓣反流的机制

• 发表时间: 2006
• 期刊: Circulation 114[Suppl I]
• 作者: Kuwahara E;Otsuji Y;et al.
• 通讯作者: et al.

Mechanism of Recurrent/Persistent Ischemic/Functional mitral regurgitation in the chronic phase after surgical annuloplasty - Importance of augmented posterior leaflet tethering

• DOI: 10.1161/circulationaha.105.000729
• 发表时间: 2006-07-04
• 期刊: CIRCULATION
• 影响因子: 37.8
• 作者: Kuwahara, Eiji;Otsuji, Yutaka;Tei, Chuwa
• 通讯作者: Tei, Chuwa