MITRAL VALVE REPLACEMENT WITH AND WITHOUT CHORDAL EXCISION

本临床试验的目的是检验二尖瓣关闭不全的假设 瓣膜装置(瓣叶、肌腱索和乳头肌)，如左侧 在更换瓣膜时完好无损，将防止近乎均匀 血流灌注后左室扩张与低心输出量相关 长期二尖瓣关闭不全的外科治疗。 具体目标是：(1)测量左心室血流动力学和内径 心脏直视手术前后超声检查：2)更换 单纯二尖瓣反流合并二尖瓣反流患者的二尖瓣病变 不切除整个二尖瓣装置；(3)确定 各组术后即刻血流动力学特点；(4) 根据运动能力、LV分析6个月和3年的结果 尺寸和血流动力学标准。 这项调查的基本原理是希望如果立即 长期接受二尖瓣置换术患者的术后病程 立位二尖瓣关闭不全可通过预防机制改变 通过维持心脏固有的物理结构来扩大左心室 左心、手术死亡率和支持措施可以减少和 长期利益可能会累积起来。 5名患者的结果一直很好。已经有两名患者 生物假体3例，圣裘德假体3例。匹配的配对 在同一时间间隔内接受二尖瓣置换术的患者 术后左心功能不全的细微变化 间期表现为典型的、与实验组不同的间期。 六个月的数据很快就会出来。

The purpose of this clincal trial is to test the hypothesis that the mitral valve apparatus (leaflet, chordae tendineae and papillary muscles), if left intact at the time of valve replacement, will prevent the nearly uniform postreperfusion left ventricular dilation and low cardiac output associated with surgical treatment of mitral insufficiency of long duration. The specific aims are: (1) measure LV hemodynamics and dimensions with ultrasound prior to and after cardiopulmonary bypass in the OR: 2) replace the mitral valve in patients with pure mitral regurgitation with and without resection of the entire mitral valve apparatus; (3) determine immediate postoperative hemodynamic characteristics of each group; (4) analyze 6 month and 3 year results in terms of exercise capacity, LV dimensions, and hemodynamic criteria. The rationale of this investigation is the hope that if the immediate postbypass course of patients receiving mitral valve replacement for long standing mitral insufficiency can be altered by the mechanism of preventing left ventricular dilation by maintaining the innate physical structures of the left heart, operative mortality and support measures may be reduced and long-term benefits may accrue. The results in five patients have been excellent. Two patients have had bioprostheses and 3 patients have had St. Jude prostheses. Matched paired patients having mitral valve replacement during the same interval have had subtle changes of left ventricular dysfunction in the postoperative interval which appear typical and different than the experimental group. Six month data will be obtained soon.