二尖瓣成形的技术要点(中英文）

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1、二尖瓣成形的技术要点JosephF.Sabik,M.D.TheClevelandClinic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N=1072Post.ChordalRupt

2、ure49%DilatedAnnulus16%ElongatedChordae24%Ant.&Post.ChordalRupture5%Ant.ChordalRupture6%生存10090807060500246810%99%93%81%Years免予再次手术10095908580750246810%Years99%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TechnicalTips&TricksforMitralValveRepairJosephF.Sabik,M.D.TheClevelandClinicSu

3、rgicalTechniquesASystematicApproachDegenerativeMitralValveDisease95%ofvalvesrepairableWithonly5or6techniquesTriangularresectionFoldingrepairArtificialchordae(orCh.Transfer)CommissureclosureAnnuloplastyProlapsingSegmentPosteriorLeafletProlapseAnteriorLeafletProlapseBileafle

4、tProlapseCommissuralProlapsePosteriorProlapseRepairTechniquesQuadrangularresectionStandardtriangularresectionSlidingrepairfoldingrepairOthersEdge-to-edgerepairArtificialchordaeAnteriorProlapseRepairTechniquesChordaltransferArtificialchordaeOthersEdge-to-edgerepairLimitedre

5、sectionCommissuralProlapseRepairTechniqueAnnuloplastyIndicationsforAnnuloplastyCorrectposteriorannulardilatationIncreaseleafletcoaptationReinforceannularsuturelinesPreventfurtherdilatationResultsPathoanatomyN=1072Post.ChordalRupture49%DilatedAnnulus16%ElongatedChordae24%An

6、t.&Post.ChordalRupture5%Ant.ChordalRupture6%Survival10090807060500246810%99%93%81%YearsFreedomfromReoperation10095908580750246810%Years99%97%93%ConclusionsMVRepair95%ValveRepairable6TechniquesSurvivalFreedomfromReoperation