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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Reparación de la válvula mitral de borde a borde sin anillo de aniloplastia para regurgitación mitral isquémica aguda
Tomasz A Timek1, Sten L Nielsen, David T Lai
1Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California 94305-5247, USA.
Circulation
|September 13, 2003
Resumen
La reparación mitral de borde a borde Alfieri no impidió la regurgitación mitral isquémica aguda (RMI) en ovejas sin anillo de anuloplastia. Se necesitan procedimientos quirúrgicos adicionales para una correcta corrección de la RMI.
Área de la Ciencia:
- Cirugía cardiovascular La cirugía cardiovascular es una cirugía cardiovascular.
- Mecánica cardíaca La mecánica cardíaca.
- Enfermedad de la válvula mitral.
Sus antecedentes:
- La reparación mitral de borde a borde de Alfieri se utiliza clínicamente con la aniloplastia de anillo para la regurgitación mitral isquémica (RMI).
- La eficacia de la reparación de Alfieri solo para la RMI no se ha descrito previamente.
Objetivo del estudio:
- Evaluar la eficacia de la reparación mitral de borde a borde de Alfieri sin anillo de aniloplastia en la prevención de la regurgitación mitral isquémica aguda (RMI).
- Evaluar el impacto de la reparación de Alfieri en la geometría mitral anular y subvalvular durante la RMI aguda.
Principales métodos:
- Diecisiete ovejas se sometieron a la implantación quirúrgica de marcadores radiopacos en el ventrículo izquierdo, el anillo mitral, los músculos papilares y los bordes del prospecto.
- La reparación de Alfieri se realizó en 7 ovejas, con 10 sirviendo como controles.
- Se utilizó la videofluoroscopia biplano y la ecocardiografía transesofágica (TEE) para evaluar el área anular mitral, las distancias del músculo papilar y los desplazamientos de los folletos durante la RMI aguda inducida.
Principales resultados:
- No se observó ninguna diferencia significativa en la gravedad de la RMI entre el grupo de reparación de Alfieri y el grupo de control.
- Ambos grupos mostraron aumentos similares en el área anular mitral y el diámetro septal-lateral durante la isquemia.
- Mientras que la distancia del músculo papilar posterior aumentó en ambos grupos, la distancia del músculo papilar anterior aumentó en los controles pero no en el grupo Alfieri, con desplazamientos similares del borde del prospecto en ambos.
Conclusiones:
- La reparación mitral de borde a borde de Alfieri por sí sola no previene la RMI aguda ni altera los cambios geométricos en la válvula mitral y el aparato subvalvular durante la isquemia.
- Los procedimientos quirúrgicos adicionales, como la aniloplastia, son esenciales para el manejo efectivo de la RMI.
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