急性性不全性ミトラル反吐症のリングアンヌロプラスティなしでエッジ・トゥ・エッジのミトラル弁修復
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
まとめ
アルフィエリー・エッジ・トゥ・エッジ・ミトラ修復は,リング・アンヌロプラスティック手術のない羊の急性性不全性ミトラ吐 (IMR) を防ぐことはできませんでした. 効果的なIMR矯正のために追加の外科手術が必要である.
科学分野:
- 心血管外科手術についてです.
- 心臓のメカニズム 心臓のメカニズム
- ミトラルバルブ病の症状について
背景:
- アルフィエリのエッジ・トゥ・エッジ・ミトラル修復は,不全性ミトラル反発 (IMR) のリングアンヌロプラスティで臨床的に使用されています.
- IMRに対するアルフィエリリペア単独療法の有効性は,以前は記述されていませんでした.
研究 の 目的:
- リングアンヌロプラスティなしでアルフィエリのエッジ・トゥ・エッジ・ミトラ修復が,急性不全性ミトラ吐 (IMR) を予防する効果を評価する.
- 急性IMR中のミトラリングラおよびサブバルブラー幾何学に対するアルフィエリ修復の影響を評価する.
主な方法:
- 17頭の羊は,外科手術により,左心室,ミトラアヌルス,パピラリ筋,および小葉片の縁に放射性不透明マーカーを植え付けられました.
- アルフィエリ修復は7頭の羊に施され,10匹がコントロールとして使用されました.
- バイプレンのビデオ光鏡検査と食道横断心声検査 (TEE) を用いて,誘発性急性IMRの際にミトラ環状領域,パピラリ筋の距離,および小葉片の移位を評価した.
主要な成果:
- アルフィエリの修理グループと対照群の間では,IMRの重度の有意な違いは観察されなかった.
- 両グループとも,イシュケミア中のミトラ環状領域とセプト・ラテラル直径の類似した増加を示した.
- 後部パピラリ筋の距離は両群とも増加したが,前部パピラリ筋の距離は対照群では増加したが,アルフィエリー群では増加しなかった.
結論:
- アルフィエリのエッジ・トゥ・エッジ・ミトラ修復だけでは,急性IMRを予防したり,イシュケミア中のミトラ弁とサブバルブラー装置の幾何学的な変化を変更したりしません.
- リングアンヌロプラスティなどの補助的な外科手術は,IMRの効果的な管理に不可欠です.
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