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胸部外科
- Author: 坂口太一1
Abstract
Background:Carpentier’s techniques for degenerative posterior mitral leaflet (PML) prolapse have been established with excellent long-term results reported. However, residual mitral regurgitation( MR) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a PML repair. Methods and Results:We retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated PML prolapse including a preoperative three-dimensional ransesophageal echocardiography( 3D-TEE) examination. Eleven had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet (AML) tethering angle as a significant predictor for residual MR [odds ratio (OR) 6.82, 95% confidence interval (CI) 1.8~33.8, p=0.0049]. Receiver operator characteristics curve analysis revealed a cut-off value of 24.3°( area under the curve 0.77), indicating that AML angle predicts residual MR. In multivariate regression analysis, smaller anteroposterior mitral annular diameter( p<0.001) and lower left ventricular ejection fraction( p=0.002) were significantly associated with higher AML angle, while left ventricular and left atrial dimension had no significant correlation. Conclusions:AML tethering in cases of PML prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3D-TEE are important for consideration of a careful surgical strategy.
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