二尖瓣成形的技術點(中英文

1、二尖瓣成形的技術要點二尖瓣成形的技術要點joseph f. sabik, m.d.the cleveland clinic手術技術手術技術一個系統(tǒng)工程一個系統(tǒng)工程退行性二尖瓣疾病退行性二尖瓣疾病95% 的瓣膜都是可成形的的瓣膜都是可成形的僅有僅有5或或6種技術種技術三角形切除三角形切除折疊成形折疊成形人工腱索人工腱索 (或腱索轉(zhuǎn)移或腱索轉(zhuǎn)移)交界縫合交界縫合瓣環(huán)成形瓣環(huán)成形不同部位脫垂不同部位脫垂后葉脫垂后葉脫垂前葉脫垂前葉脫垂雙葉脫垂雙葉脫垂交界脫垂交界脫垂后葉脫垂成形技術后葉脫垂成形技術長方形切除長方形切除標準成形標準成形 三角形切除三角形切除滑行成形滑行成形 折疊成形折疊成形其它其它雙孔

2、法成形雙孔法成形人工腱索人工腱索前葉脫垂成形技術前葉脫垂成形技術腱索轉(zhuǎn)移腱索轉(zhuǎn)移人工腱索人工腱索其它其它雙孔法雙孔法有限切除有限切除交界脫垂成形技術交界脫垂成形技術瓣環(huán)成形瓣環(huán)成形瓣環(huán)成形的指征瓣環(huán)成形的指征矯正后瓣環(huán)擴大矯正后瓣環(huán)擴大增加瓣葉貼合面增加瓣葉貼合面增強版換縫線增強版換縫線預防將來擴張預防將來擴張結果結果病理解剖病理解剖n = 1072生存生存免予再次手術免予再次手術結論結論二尖瓣成形二尖瓣成形95% 瓣膜可成形瓣膜可成形6 種技術種技術生存率生存率免予再次手術率免予再次手術率technical tips & tricks for mitral valve repairj

3、oseph f. sabik, m.d.the cleveland clinicsurgical techniquesa systematic approachdegenerative mitral valve disease95% of valves repairablewith only 5 or 6 techniquestriangular resectionfolding repairartificial chordae (or ch. transfer)commissure closureannuloplastyprolapsing segmentposterior leaflet

4、prolapseanterior leaflet prolapsebileaflet prolapsecommissural prolapseposterior prolapse repair techniquesquadrangular resectionstandard triangular resectionsliding repair folding repairothersedge-to-edge repairartificial chordaeanterior prolapse repair techniqueschordal transferartificial chordaeo

5、thersedge-to-edge repairlimited resectioncommissural prolapse repair techniqueannuloplastyindications for annuloplastycorrect posterior annular dilatationincrease leaflet coaptationreinforce annular suture linesprevent further dilatationresultspathoanatomyn = 1072survivalfreedom from reoperationconcl