MITRAL VALVE REPLACEMENT WITH AND WITHOUT CHORDAL EXCISION

这项临床试验的目的是检验一种假设，即 二尖瓣装置(瓣叶、肌腱索和乳头肌) 如果在更换瓣膜时保持完好，将防止 灌流后左心室均一性扩张和低心输出量 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 手术室体外循环前后超声检查；(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，如果立即进行后搭桥 长期接受二尖瓣置换术患者的病程 二尖瓣关闭不全可通过预防左心衰的机制来改变 通过维持心脏固有的物理结构来扩张脑室 左心、手术死亡率和支持措施可能会减少 长期利益可能会累积起来。 5名患者的结果一直很好。有两名患者 需要术后支持。目前还没有围术期死亡病例。 与该程序相关联。

The purpose of this clinical 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 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 required postoperative support. There have been no perio-operative deaths associated with the procedure.