17 декабря 2001 00:00 |
«Bow-tie» mitral valve repair: an adjuvant technique for ischemic mitral regurgitation
BACKGROUND: Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double- orifice valve, with reported adequate control of mitral regurgitation.
METHODS: We started to use the «bow-tie» repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4). Mean follow-up was 336 days (range, 82 to 551 days) with no postoperative deaths.
RESULTS: Mitral regurgitation decreased from 3.6+/−0.5 to 0.8+/- 0.4 (p < 0.0001), with a concomitant increase in ejection fraction from 33%+/−13% to 45%+/−11% (p = 0.0156) before hospital discharge. Mitral valve area, measured by pressure half-time, decreased from a mean of 2.5+/−0.3 to 2.1+/−0.3 cm2, with a mean transvalvular gradient of 4.5+/- 2.0 mm Hg. In patients whose mitral valve was repaired using the bow- tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm2 during exercise, further supporting the concept that this technique preserves mitral valve annular function.
CONCLUSIONS: These observations suggest that the bow-tie repair may offer advantages over conventional techniques of mitral valve repair and should be considered as an adjunct, especially in patients with impaired left ventricular function.
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