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1、二尖瓣成形的技术要点,Joseph F. Sabik, M.D. The Cleveland Clinic,手术技术 一个系统工程,退行性二尖瓣疾病,95% 的瓣膜都是可成形的 仅有5或6种技术 三角形切除 折叠成形 人工腱索 (或腱索转移) 交界缝合 瓣环成形,不同部位脱垂,后叶脱垂 前叶脱垂 双叶脱垂 交界脱垂,后叶脱垂成形技术,长方形切除 标准成形 三角形切除 滑行成形 折叠成形 其它 双孔法成形 人工腱索,前叶脱垂成形技术,腱索转移 人工腱索 其它 双孔法 有限切除,交界脱垂成形技术,瓣环成形,瓣环成形的指征,矫正后瓣环扩大 增加瓣叶贴合面 增强版换缝线 预防将来扩张,结果,病理解剖,
2、N = 1072,Post. Chordal Rupture 49%,Dilated Annulus 16%,Elongated Chordae 24%,Ant. & Post. Chordal Rupture 5%,Ant. Chordal Rupture 6%,生存,100 90 80 70 60 50,0 2 4 6 8 10,%,99%,93%,81%,Years,免予再次手术,100 95 90 85 80 75,0 2 4 6 8 10,%,Years,99%,97%,93%,结论,二尖瓣成形 95% 瓣膜可成形 6 种技术 生存率 免予再次手术率,Technical Tips &
3、 Tricks for Mitral Valve Repair,Joseph F. Sabik, M.D. The Cleveland Clinic,Surgical Techniques A Systematic Approach,Degenerative Mitral Valve Disease,95% of valves repairable With only 5 or 6 techniques Triangular resection Folding repair Artificial chordae (or Ch. Transfer) Commissure closure Annu
4、loplasty,Prolapsing Segment,Posterior Leaflet Prolapse Anterior Leaflet Prolapse Bileaflet Prolapse Commissural Prolapse,Posterior Prolapse Repair Techniques,Quadrangular resection Standard triangular resection Sliding repair folding repair Others Edge-to-edge repair Artificial chordae,Anterior Prol
5、apse Repair Techniques,Chordal transfer Artificial chordae Others Edge-to-edge repair Limited resection,Commissural Prolapse Repair Technique,Annuloplasty,Indications for Annuloplasty,Correct posterior annular dilatation Increase leaflet coaptation Reinforce annular suture lines Prevent further dila
6、tation,Results,Pathoanatomy,N = 1072,Post. Chordal Rupture 49%,Dilated Annulus 16%,Elongated Chordae 24%,Ant. & Post. Chordal Rupture 5%,Ant. Chordal Rupture 6%,Survival,100 90 80 70 60 50,0 2 4 6 8 10,%,99%,93%,81%,Years,Freedom from Reoperation,100 95 90 85 80 75,0 2 4 6 8 10,%,Years,99%,97%,93%,Conclusions,MV Repair 95% Valve Repairable 6 Techniques Survival Freedom from Reoperation,