Artificial chordae replacement with expanded polytetrafluoroethylene （ePTFE; Gore-Tex, W.L.Gore and Associates Inc., Flagstaff, AZ, USA） is an established technique for mitral valve repair with excellent long-term r...Artificial chordae replacement with expanded polytetrafluoroethylene （ePTFE; Gore-Tex, W.L.Gore and Associates Inc., Flagstaff, AZ, USA） is an established technique for mitral valve repair with excellent long-term results. There is growing interest in the application of artificial chordae to correct mitral valve regurgitation caused by anterior leaflet prolapse. Application of pre-measured artificial chordae facilitates creation of chordae with appropriate length. The aim of this study was to illustrate the technique for creation of pre-measured artificial chordae.展开更多
目的总结腱索转移和人工腱索技术在二尖瓣成形术中的临床应用经验，以提高临床治疗效果。方法回顾性分析2008年1月至2013年2月采用腱索转移和人工腱索技术治疗以二尖瓣前叶脱垂为主（均为退行性二尖瓣关闭不全）74例患者的临床资料，其...目的总结腱索转移和人工腱索技术在二尖瓣成形术中的临床应用经验，以提高临床治疗效果。方法回顾性分析2008年1月至2013年2月采用腱索转移和人工腱索技术治疗以二尖瓣前叶脱垂为主（均为退行性二尖瓣关闭不全）74例患者的临床资料，其中男34例，女40例，年龄22～64（48．00±6．40）岁。按手术方法不同将74例患者分为两组，腱索转移组（n=42）：行腱索转移术，采用后叶腱索转移至前叶的方法；人工腱索组（n=32）：行人工腱索术，采用的是线圈技术。术后观察围术期死亡、并发症发生情况和二尖瓣反流程度。随访期间行超声心动图观察左心室射血分数、左心室舒张期末内径、收缩期末内径等指标变化。结果腱索转移组和人工腱索组均无围手术期死亡，2例开胸止血，9例术后出现阵发性心房颤动，给予静脉滴注胺碘酮处理后好转。出院前复查心脏超声心动图提示：腱索转移组患者有少量反流5例，微量反流12例，未见明显反流25例。人工腱索组有少量反流6例，微量反流15例，未见明显反流11例。随访70例，随访率94．59％（70／74）。两组患者术后6个月左心室射血分数分别较出院前明显增加（腱索转移组：64．00％±4．20％VS．55．00％±5．10％；人工腱索组：63．00％±3．50％vs．56．00％±4．20％），左心室舒张期末内径[腱索转移组：（47．00±2．20）mm vs ．（58．00±6．90）mm；人工腱索组：（45．00±3．80）mm vs．（57．00±5．10）mm]、收缩期末内径分别较术前明显缩小（P〈0．05）。腱索转移组术前、出院前、术后6个月左心室射血分数、左心室舒张期末内径、收缩期末内径与人工腱索组差异均无统计学意义（P〉0．05）。腱索转移组术后14个月有1例患者因二尖瓣大量反流再次行二尖瓣置换术。人工腱索组有1例患者于术后6个月由于频繁出现血�展开更多
Background Repair of anterior mitral leaflet （AML） prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible tec...Background Repair of anterior mitral leaflet （AML） prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.Methods Between January 2002 and June 2009, the operation of chordal transfer based on the ＂edge-to-edge＂technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet.After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association （NYHA） functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve： the cross-sectional area of the mitral valve was 3.3-4.8 cm2 （mean （3.78：±0.52） cm2）, the mean regurgitation area was （0.45：±0.22） cm2. At the same time, both dimension of left atrium and left ventricle reduced significantly （left atrium diameter： pre-operation （48.26±11.12） mm, post-operation （37.57±9.56） mm, P 〈0.05; the end-diastolic diameter of the left ventricle：pre-operation （61.43±8.24） mm, post-operation （42.35±10.79） mm, P〈0.01）.Conclusion ＂Edge-to-edge＂ chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.展开更多
Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to mak...Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to make the loops preoperatively and rebuild the elongated/ruptured chordae intraoperatively. Materials and method From June 2011 to February 2012, 19 consecutive cases with mitral anterior leaflet prolapse underwent valve repair procedures. Echocardiography was used to determine the length of normal chordae that the prolapsed leaflets should have for normal coaptation. The artificial chordae was fabricated in loops according to echo-determined length. Results All patients survived the operations. 2.8 preoperatively prepared loops were used per patient to restore the anterior leaflets, as well as posterior leaflets. Artificial mitral valve rings were applied to 18 patients for mitral annuloplasty. 16 patients were underwent different concomitant operations. Echocardiographic results at discharge showed that grade of mitral regurgitation, left ventricular end-diastolic, end-systolic dimension de-creased definitely,respectively from 3.26 ± 1.10, 53.79 ± 15.03 mm, 33.00 ± 12.05 mm preoperatively to 0.47 ± 0.61 （P 〈 0.01）, 44.74±10.28 mm （P 〈 0.01）, 30.16 ± 10.58 mm （P 〈 0.05） postoperatively. All patients improved clinically and NYHA functional class Conclusion Reconstruction of prolapsed anterior decreased significantly from 2.17 ± 0.81 to 1.12 ± 0.33. leaflet chordae with artificial loops in preoperatively echo-de-termined length is safe and effective, and initial clinical outcome is satisfactory.展开更多
文摘Artificial chordae replacement with expanded polytetrafluoroethylene （ePTFE; Gore-Tex, W.L.Gore and Associates Inc., Flagstaff, AZ, USA） is an established technique for mitral valve repair with excellent long-term results. There is growing interest in the application of artificial chordae to correct mitral valve regurgitation caused by anterior leaflet prolapse. Application of pre-measured artificial chordae facilitates creation of chordae with appropriate length. The aim of this study was to illustrate the technique for creation of pre-measured artificial chordae.
文摘目的总结腱索转移和人工腱索技术在二尖瓣成形术中的临床应用经验，以提高临床治疗效果。方法回顾性分析2008年1月至2013年2月采用腱索转移和人工腱索技术治疗以二尖瓣前叶脱垂为主（均为退行性二尖瓣关闭不全）74例患者的临床资料，其中男34例，女40例，年龄22～64（48．00±6．40）岁。按手术方法不同将74例患者分为两组，腱索转移组（n=42）：行腱索转移术，采用后叶腱索转移至前叶的方法；人工腱索组（n=32）：行人工腱索术，采用的是线圈技术。术后观察围术期死亡、并发症发生情况和二尖瓣反流程度。随访期间行超声心动图观察左心室射血分数、左心室舒张期末内径、收缩期末内径等指标变化。结果腱索转移组和人工腱索组均无围手术期死亡，2例开胸止血，9例术后出现阵发性心房颤动，给予静脉滴注胺碘酮处理后好转。出院前复查心脏超声心动图提示：腱索转移组患者有少量反流5例，微量反流12例，未见明显反流25例。人工腱索组有少量反流6例，微量反流15例，未见明显反流11例。随访70例，随访率94．59％（70／74）。两组患者术后6个月左心室射血分数分别较出院前明显增加（腱索转移组：64．00％±4．20％VS．55．00％±5．10％；人工腱索组：63．00％±3．50％vs．56．00％±4．20％），左心室舒张期末内径[腱索转移组：（47．00±2．20）mm vs ．（58．00±6．90）mm；人工腱索组：（45．00±3．80）mm vs．（57．00±5．10）mm]、收缩期末内径分别较术前明显缩小（P〈0．05）。腱索转移组术前、出院前、术后6个月左心室射血分数、左心室舒张期末内径、收缩期末内径与人工腱索组差异均无统计学意义（P〉0．05）。腱索转移组术后14个月有1例患者因二尖瓣大量反流再次行二尖瓣置换术。人工腱索组有1例患者于术后6个月由于频繁出现血�
文摘Background Repair of anterior mitral leaflet （AML） prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.Methods Between January 2002 and June 2009, the operation of chordal transfer based on the ＂edge-to-edge＂technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet.After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association （NYHA） functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve： the cross-sectional area of the mitral valve was 3.3-4.8 cm2 （mean （3.78：±0.52） cm2）, the mean regurgitation area was （0.45：±0.22） cm2. At the same time, both dimension of left atrium and left ventricle reduced significantly （left atrium diameter： pre-operation （48.26±11.12） mm, post-operation （37.57±9.56） mm, P 〈0.05; the end-diastolic diameter of the left ventricle：pre-operation （61.43±8.24） mm, post-operation （42.35±10.79） mm, P〈0.01）.Conclusion ＂Edge-to-edge＂ chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.
基金supported by the Natural Science Foundation of Guangdong Province, China (Grant No.S2011010005828)
文摘Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to make the loops preoperatively and rebuild the elongated/ruptured chordae intraoperatively. Materials and method From June 2011 to February 2012, 19 consecutive cases with mitral anterior leaflet prolapse underwent valve repair procedures. Echocardiography was used to determine the length of normal chordae that the prolapsed leaflets should have for normal coaptation. The artificial chordae was fabricated in loops according to echo-determined length. Results All patients survived the operations. 2.8 preoperatively prepared loops were used per patient to restore the anterior leaflets, as well as posterior leaflets. Artificial mitral valve rings were applied to 18 patients for mitral annuloplasty. 16 patients were underwent different concomitant operations. Echocardiographic results at discharge showed that grade of mitral regurgitation, left ventricular end-diastolic, end-systolic dimension de-creased definitely,respectively from 3.26 ± 1.10, 53.79 ± 15.03 mm, 33.00 ± 12.05 mm preoperatively to 0.47 ± 0.61 （P 〈 0.01）, 44.74±10.28 mm （P 〈 0.01）, 30.16 ± 10.58 mm （P 〈 0.05） postoperatively. All patients improved clinically and NYHA functional class Conclusion Reconstruction of prolapsed anterior decreased significantly from 2.17 ± 0.81 to 1.12 ± 0.33. leaflet chordae with artificial loops in preoperatively echo-de-termined length is safe and effective, and initial clinical outcome is satisfactory.
