RING+STRING:成功的修复技巧,以严重的传单绑定为基础,用于缺血性额头吐
Frank Langer1, Takashi Kunihara, Klaus Hell
1Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg, Germany. frank.langer@uks.eu
Circulation
|September 16, 2009
概括
辅助乳头肌肉重新定位 (STRING) 结合环结膜整形术 (RING) 降低了缺血性肌肉回患者的双肩吐. 这种新的技术提高了维修耐用性,并促进了反向改造.
科学领域:
- 心血管外科心血管外科
- 心脏外科手术 心脏外科手术
- 心脏门维修 心脏门维修
背景情况:
- 缺血性甲骨管反 (IMR) 常常呈现残留/复发性甲骨管反 (MR) 在多达30%的患者中,在环结膜整形术 (RING) 后.
- 标准RING主要解决环状扩张,但未能纠正由移位的乳头肌肉 (PM) 引起的严重的叶片绑定.
研究的目的:
- 评估辅助横腔 suture技术 (STRING) 的有效性,用于在IMR和RING接受的严重传单绑定患者的乳头肌肉重新定位.
主要方法:
- 采用了一种新的STRING技术,涉及转食管回声心脏图 (TEE) 指导PM重置在负载的跳动心脏中的指导.
- 通过动脉切除术在后部PM中 anchored的Teflon-pledgeted suture,并根据TEE指导绑定.
- 这与30名高风险患者的部分环结婚整形 (中位数为29毫米) 结合在一起 (顶高度≥10毫米).
主要成果:
- 结合RING+STRING技术显著减少了帐高度 (14±2毫米到6±1毫米) 和帐面积 (3.9±0.9厘米2到1.0±0.2厘米2).
- 观察到后面的乳头肌肉和大动脉中枢连续性之间的距离显著减少 (44±4毫米到37±3毫米).
- 两年存活率与历史对照 (89%与73%相比) 相当,但无MR>II显著更高 (94%与71%相比).
- 与对照组不同的是,RING+STRING组显示出显著的反向重塑,并减少了末端透气和末端静脉心室直径.
- 研究小组中只有1名患者需要因退行性MR重新手术,而对于复发性功能MR的2名对照患者而言,只有1名患者需要重新手术.
结论:
- 新的STRING技术,当与RING结合使用时,可以有效地减轻IMR患者严重传单绑定严重的修复失败的高风险.
- 这种方法导致了显著的反向改造和改善的长期结果,为复杂的IMR病例提供了有希望的解决方案.
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