Kyobu geka. The Japanese journal of thoracic surgery · 2012
[How to repair a mitral valve prolapse;an assessment of operative techniques dependent on late results].
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Sawazaki Masaru, Tomari Shiro, Izawa Naoto
Аннотация
BACKGROUND: In this study, we assessed the repair techniques employed for mitral valve prolapse.
PATIENTS AND METHODS: Between 1992 and 2011, we repaired 173 consecutive patients with mitral valve prolapse. The mean age of the patients was 60.1 years and 68.6% were male. For anterior leaflet (AL) prolapse, 27 patients with fibroelastic deficiency (FED) were treated with chordal replacement (CR). In 21 patients with Barlow type, 2 were repaired with CR and the remaining 19 were repaired with resection. In 130 patients with a prolapse of the posterior leaflet (PL), we selected quadrangular resection( QR:44), sliding plasty( SP:12), folding plasty and CR. More recently, triangular resection (TrR:22) was selected for ≤18 mm height leaflets, and an hourglass resection( HgR:21) for high leaflets.Hourglass represents the shape of the resection.
RESULTS: In 1 patient of the AL CR group, the expanded polytetrafluoroethylene (ePTFE) was broken. Other patients in this group showed no mitral regurgitation (MR) and no re-operation during 16 years. Two patients receiving CR for AL Barlow received re-repair, whilst the other 19 patients in this group displayed good results over the following 19 years. In the QR and SP groups, 1 patient was rerepaired,whilst 3 patients displayed complicated mitral stenosis. In the TrR and HgR groups, no MR,no re-operation and no late deaths occurred during the following 4.5 years.
CONCLUSIONS: CR for AL FED, resection for AL Barlow and TrR or HgR for PL were durable techniques for the treatment of mitral valve prolapse.
PATIENTS AND METHODS: Between 1992 and 2011, we repaired 173 consecutive patients with mitral valve prolapse. The mean age of the patients was 60.1 years and 68.6% were male. For anterior leaflet (AL) prolapse, 27 patients with fibroelastic deficiency (FED) were treated with chordal replacement (CR). In 21 patients with Barlow type, 2 were repaired with CR and the remaining 19 were repaired with resection. In 130 patients with a prolapse of the posterior leaflet (PL), we selected quadrangular resection( QR:44), sliding plasty( SP:12), folding plasty and CR. More recently, triangular resection (TrR:22) was selected for ≤18 mm height leaflets, and an hourglass resection( HgR:21) for high leaflets.Hourglass represents the shape of the resection.
RESULTS: In 1 patient of the AL CR group, the expanded polytetrafluoroethylene (ePTFE) was broken. Other patients in this group showed no mitral regurgitation (MR) and no re-operation during 16 years. Two patients receiving CR for AL Barlow received re-repair, whilst the other 19 patients in this group displayed good results over the following 19 years. In the QR and SP groups, 1 patient was rerepaired,whilst 3 patients displayed complicated mitral stenosis. In the TrR and HgR groups, no MR,no re-operation and no late deaths occurred during the following 4.5 years.
CONCLUSIONS: CR for AL FED, resection for AL Barlow and TrR or HgR for PL were durable techniques for the treatment of mitral valve prolapse.