| Background ?Compared with mitral valve replacement,there are several advantages in mitral valvuloplasty,so recently more and more sights are caught on mitral valve repair. According to different etiology,the surgeon can apply annuloplasty , triangular resection,quadrangular resection, replacement or transposition of chordae tendineae and so on to treat mitral regurgitation (MR).This study was performed to evaluate the results of the clinical application which is using Gore-tex suture as an artificial chordae on mitral valve repair in patients with mitral regurgitation.The key part of this study is to compared the effect and prospects and applications of using Gore-tex suture as an artificial chordae on mitral valve repair with others mitral valve repair which are not using Gore-tex suture.And also the study was going to evaluate the satisfactory effect,significant influence on left ventricular diastolic function and of mitral valvuloplasty with Gore-Tex suture as an artificial chordae tendineae.And the study would evaluate there is similar hemodynamic change compared with a physiological mitral valve or not. ObjectiveTo evaluate the early effects,prospects and applications of mitral valvuloplasty with Gore-Tex suture as an artificial chordae tendineae in patients with partial rupture chordae tendineae of mitral regurgitation.Methods1. MaterialFrom Dec.2008 to Jan.2010,a total of 56 patients with cardiac disfunction caused mitral regurgitation.These patients are from Guangdong Province Hospital Cardiovascular Institute with moderate to severe mitral regurgitation,were performed mitral valve repair.The patients who were picked in were like these:1. Mitral regurgitation with a chordal elongation or rupture.2.There were no contracture on chordal even though there was calcification or fibrosis on prefrontal valve.3.There were no excrescence or perforation on prefrontal valve.4.There was no surgical contraindications.2. Methods56 cases with mitral regurgitation were divided into two groups. Quadrangular resection was performed on 28 cases with MR in control group,and mitral valvuloplasty with Gore -Tex suture as an artificial chordae tendineae was performed on 28 cases with anterior or bileaflet proplapse in experimental group, and ring annuloplasty (Edwards ring) was all used in experimental group,and some in control group.There are 51 patients using ring annuloplasty (Edwards) .The technique we used in the operations was replacement of chordae tendineae with expanded polytetrafluoroethylenesutures (4CV Gore-Tex).The degree of mitral regurgitation,left ventricular dimension in end-diastole(LVDd) and left atrium internal diameter (LAID),The left ventricular ejection fraction(LVEF),as well as MR were detected before the operation with TEE.After tihe operation and the the time when followed up,these date were detected by TEE or other echocardiography using color Doppler and tissue Doppler imaging.And all the patients except the patients who were dead after operation or undergoing mitral valve replacement were followed up for 3-12 months.3. ResultsEarly postoperatively, one patient died of multiple organ failure,one patient die of severe pulmonary infection, 2 patients underwent mitral valve replacement with mechanical prosthesis valve for sever mitral regurgitation. And all the patients except the patients who were dead after operation or undergoing mitral valve replacement were followed up for 3-12 months.Except one patient had a mitral regurgitation,the rest of all patients had their cardiac function improved apparently.1.There was no significant (F<0.001, P =0.925) between two groups on LVDd.The Statistical Results of LVDd before operation, Postoperative week and 3 months after operation were significan(tF=17.586,P<0.001).There is no interaction between time and treament(F=1.005,P=0.374).2.There was no significant (F=0.069, P=0.793) between two groups on LAId.The Statistical Results of LAId before operation, Postoperative week and 3 months after operation were significan(tF=38.909,P<0.001).There is no interaction between time and treament(F=2.779,P=0.072).3.There is no significant (F =1.930, P=0.171) between two groups on MR.The Statistical Results of MR before operation, Postoperative week and 3 months after operation were significant(F=97.191,P<0.001).There is no interaction between time and treament(F=0.846,P=0.435).4. There is no significant (F=0.071 P=0.791) between two groups on LVEF.The Statistical Results of LVEF before operation, Postoperative week and 3 months after operation were significant(F=6.375,P=0.003).There is no interaction between time and treament(F=1.079,P=0.348).4. ConclusionMitral valvuloplasty with Gore-Tex suture as an artificial chordae tendineae technique is safe,available and it could get an improvement on left ventricular diastolic function.And mitral valvuloplasty with Gore-Tex suture as an artificial chordae tendineae technique could be used in anterior leaflet prolapse or posterior leaflet prolapse.It increase the area and contacts of valves,but it is hard to measure the length of chordae.The surgery must have a good technology. |
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