二尖瓣修补的方法东方的观点(中英文)课件

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,二尖瓣修补的方法东方的观点（中英文）,二尖瓣修补的方法东方的观点（中英文）,1,无症状二尖瓣返流治疗结果的定量分析,Maurice Enrique-Saran et al. N Engl J Med 2005;352:875-83,无症状二尖瓣返流治疗结果的定量分析Maurice Enriq,2,二尖瓣修补的方法东方的观点(中英文)课件,3,二尖瓣修补的方法东方的观点(中英文)课件,4,Shuhaiber et al. Eur J Card Thorac Surg. 2007;31:267-75,Chords,Olivieria 1983,Survival,1.23,0.38,4.04,Chords,1.23,0.38,4.04,Degen,Gillinov 2003,Survival,1.67,1.30,2.15,Degen,Lee 1997,Survival,1.42,0.84,2.40,Degen,Mohty 2001,Survival,1.75,1.24,2.46,Degen,Yacoub 1981,Survival,2.34,0.91,6.05,Degen,1.68,1.39,2.02,Ischemic,Califiore 2004,Survival,0.78,0.19,3.16,Ischemic,Cohn 1995,Survival,0.53,0.18,1.53,Ischemic,Grossi 2001,Survival,1.34,0.92,1.95,Ischemic,Mantovani 2004,Survival,1.48,0.42,5.20,Ischemic,1.18,0.83,1.69,Mixed,Adebo 1984,Survival,1.48,0.33,6.70,Mixed,Akins 1994,Survival,1.60,0.76,3.36,Mixed,Craver 1990,Survival,1.16,0.39,3.50,Mixed,Enriguez-Sarano 99?,Survival,1.64,1.13,2.38,Mixed,Galloway 1989,Survival,1.55,1.02,2.35,Mixed,Hausmann 1999,Survival,0.86,0.58,1.26,Mixed,Kawachi 1991,Survival,4.33,0.64,29.34,Mixed,Perier 1984,Survival,2.39,1.30,4.37,Mixed,Sand 1987,Survival,1.63,1.04,2.57,Mixed,Thourani 2003,Survival,1.53,1.26,1.86,Mixed,1.49,1.24,1.78,Rheumatic,Antunes 1987,Survival,2.13,1.28,3.53,Rheumatic,Yau 2000,Survival,2.65,1.47,4.78,Rheumatic,2.33,1.59,3.43,Overall,1.58,1.41,1.78,危险比,Shuhaiber et al. Eur J Card Th,5,修补,vs,置换,血流动力学更稳定,维持心室的功能,避免使用人工瓣膜,不会出现血栓栓塞和出血,感染机率降低,技术和经验至关重要,修补 vs 置换 血流动力学更稳定 技术和经,6,分型,瓣叶运动,描述,Ia,正常,瓣环扩张,Ib,瓣叶穿孔,IIa,过度,腱索延长,IIb,腱索破裂,IIc,乳头肌,梗死,/,延长,IIIa,受限,瓣叶缩短或粘合,或腱索融合,IIIb,左心室功能异常或动脉瘤导致瓣叶圈合,IV,不定,乳头肌功能失调,退行性二尖瓣返流的,Carpentier,分级,分型瓣叶运动描述Ia正常瓣环扩张Ib瓣叶穿孔IIa过度腱索延,7,退行性二尖瓣疾病的修补手术,后瓣叶,-,公认的标准修补术,前瓣叶,技术难度更高，结果差异较大,联合脱垂, Carpentiers,修补术,后瓣叶, Q,形切除术,前瓣叶,瓣叶转位,退行性二尖瓣疾病的修补手术后瓣叶- 公认的标准修补术后瓣叶,8,人工腱索, Gore-Tex 5/0,人工腱索 Gore-Tex 5/0,9,退行性,MV,修补术的结果,西方,vs,东方,人数,死亡率,STS,数据库,1.5 %,Gillinov 2008,3544,0.3 %,De Bonis 2006,738,0.3 %,Suri* 2006,64,1.6 %*,David 2005,701,0.7 %,Kasegawa 2006,181,1.3 %,Nakajima 2005,16,0.0 %,Cinghatanadgige 2003,43,2.3 %,Song 2003,184,1.0 %,退行性MV修补术的结果西方 vs 东方 人数死亡率STS,10,退行性二尖瓣返流,东方,=,西方,TEE,的重要性,返流束的方向判断容易出错,盐水注射试验,:,有或无,Barlows ,罕见但是很困难,退行性二尖瓣返流 东方 = 西方,11,分型,瓣叶活动,描述,Ia,正常,瓣环扩张,Ib,瓣叶穿孔,IIa,过度,腱索延长,IIb,腱索断裂,IIc,乳头肌,梗死,/,延长,IIIa,受限,瓣叶缩短或粘合,或融合,IIIb,左心室功能异常或动脉瘤导致的瓣叶圈合,IV,不定,乳头肌功能失调,改良,Carpentier,分级,:,缺血性,MR,分型瓣叶活动描述Ia正常瓣环扩张Ib瓣叶穿孔IIa过度腱索延,12,缺血性二尖瓣返流的机制,慢性,Lveine et al. Circulation 112(5) August 745-58,缺血性二尖瓣返流的机制 慢性 Lveine et a,13,Bursi, F. et al. Circulation 2005;111:295-301,773,例,MI,后患者，根据超声心动图检查,MR,严重程度的不同分组，,30,天内各组的总存活率,(,实线代表无,MR,，点线代表轻度,MR,，虚线代表中度或重度,),NIL MR,50,%,Mild MR,38,%,Mod or severe MR,12,%,Bursi, F. et al. Circu,14,亚洲的问题有多严重,?,中国国家心血管疾病中心,2005,报道,:,全国缺血性心脏病的发病率为,4.2%,每年新增的,MI,患者为,500,000,例,城市预测,预计每年新增的缺血性,MR,患者例数：,60,000,亚洲的问题有多严重?中国国家心血管疾病中心,15,院内死亡率,1.4 %,修补,vs 21 %,置换,P = 0.06,5,年再次手术率,修补,14 % vs,置换,3 %,P = 0.003,缺血性二尖瓣返流中二尖瓣修补和二尖瓣置换的比较,Osman O. Al-Radi, MBBS, Peter C. Austin, PhD, Jack V. Tu, MD, Tirone E. David, MD, and Terrence M. Yau, MD, MS,院内死亡率 5 年再次手术率缺血性二尖瓣返流中二尖瓣修补和二,16,慢性缺血性,MR,的各种修补技术,瓣环成形术,瓣口过小,Bolling,(n=140),Carpentier,法,Acar,(n=44),第二腱索松解,David,(n=30),LV,成形术，比如,: DorsMericanti,(n=46),后乳头肌复位术,Kron,(n=18),缘对缘修补术,Bhudia,(n=146)*,慢性缺血性MR的各种修补技术瓣环成形术 瓣口过小 B,17,北京,上海,年份,1976 - 97,1978 - 03,患者,4505,3416,女性,(%),52.4,39.6,年龄,40.5,40.0,风湿性,(%),80,92,二尖瓣,(%),54.3,100,机械瓣,100,100,死亡率,(%),3.8,3.3,10,年存活率,(%),93,94,出血,&,血栓,%,患者，年份,1.59,0.85,中国二尖瓣手术的回顾,北京上海年份 1976 - 971978 - 03患者450,18,Shuhaiber et al. Eur J Card Thorac Surg. 2007;31:267-75,Chords,Olivieria 1983,Survival,1.23,0.38,4.04,Chords,1.23,0.38,4.04,Degen,Gillinov 2003,Survival,1.67,1.30,2.15,Degen,Lee 1997,Survival,1.42,0.84,2.40,Degen,Mohty 2001,Survival,1.75,1.24,2.46,Degen,Yacoub 1981,Survival,2.34,0.91,6.05,Degen,1.68,1.39,2.02,Ischemic,Califiore 2004,Survival,0.78,0.19,3.16,Ischemic,Cohn 1995,Survival,0.53,0.18,1.53,Ischemic,Grossi 2001,Survival,1.34,0.92,1.95,Ischemic,Mantovani 2004,Survival,1.48,0.42,5.20,Ischemic,1.18,0.83,1.69,Mixed,Adebo 1984,Survival,1.48,0.33,6.70,Mixed,Akins 1994,Survival,1.60,0.76,3.36,Mixed,Craver 1990,Survival,1.16,0.39,3.50,Mixed,Enriguez-Sarano 99?,Survival,1.64,1.13,2.38,Mixed,Galloway 1989,Survival,1.55,1.02,2.35,Mixed,Hausmann 1999,Survival,0.86,0.58,1.26,Mixed,Kawachi 1991,Survival,4.33,0.64,29.34,Mixed,Perier 1984,Survival,2.39,1.30,4.37,Mixed,Sand 1987,Survival,1.63,1.04,2.57,Mixed,Thourani 2003,Survival,1.53,1.26,1.86,Mixed,1.49,1.24,1.78,Rheumatic,Antunes 1987,Survival,2.13,1.28,3.53,Rheumatic,Yau 2000,Survival,2.65,1.47,4.78,Rheumatic,2.33,1.59,3.43,Overall,1.58,1.41,1.78,Shuhaiber et al. Eur J Card Th,19,分型,瓣叶活动,描述,修补技术,Ia,正常,瓣环扩张,瓣环成形术,Ib,瓣叶穿孔,IIa,过度,腱索延长,Gore-Tex or,缩短术,IIb,腱索断裂,IIc,乳头肌,梗死,/,延长,Gore-Tex or,缩短术,IIIa,受限,瓣叶缩短或粘合,或腱索融合,心包补片,口角成形术,腱索,乳头肌开窗术,IIIb,左心室功能异常或动脉瘤导致瓣叶圈合,IV,不定,乳头肌功能失调,风湿性二尖瓣返流的病理生理学,分型瓣叶活动描述修补技术Ia正常瓣环扩张 瓣环成形术Ib瓣叶,20,风湿性二尖瓣返流重建手术的远期预后（,29,年）,Sylvain Chauvaud, MD; Jean-Franois Fuzellier, MD; Alain Berrebi, MD; Alain Deloche, MD;Jean-Nol Fabiani, MD; Alain Carpentier, MD, PhD,Methods and Results,From 1970 to 1994, 951 patients with rheumatic MV insufficiency were operated on with the reconstructive techniques elaborated by Alain Carpentier. Mean age was 25.8 years (4 to 75), and sinus rhythm was present in 63%. The functional classification used was type I, normal leaflet motion, 71 patients (7%); type II, prolapsed leaflet, 311 patients (33%); and type III, restricted leaflet motion, 345 patients (36%). The combined lesion of prolapse of the anterior leaflet and restriction of the posterior was present in 224 patients (24%).,Surgical techniques used were implantation of a prosthetic ring in 95%, shortening of the chords and leaflet enlargement with autologous pericardium, and commissurotomy. Hospital mortality rate was 2%. The mean follow-up was 12 years (maximum, 29 years): 8618 patients per year. Actuarial survival was 89,19% at 10 years and 82,18% at 20 years. The rate of thromboembolic events was 0.4% patients per year (33 events), with 3 deaths. Freedom from reoperation was 82,19% at 10 years and 55,25% at 20 years. The main cause (83%) of reoperation was progressive fibrosis of the MV. The actuarial rate of reoperation was 2% patients per year and was correlated to the degree of preoperative fibrosis.,功能分级,型，瓣叶活动正常的患者有,71,例（,7%,）；,型，瓣叶脱垂者,311,例（,33%,）；,型，瓣叶活动受限者,345,例（,36%,）。二尖瓣前叶脱垂同时伴后叶受限的患者共,224,例（,24%,）。,随访,12,年（最长,29,年）：每年,8618,例患者。,10,年的实际存活率为,8919%,，,20,年为,8218%,。每年血栓栓塞事件的发生率为,0.4%,（,33,例），其中,3,例患者死亡。,10,年内无需再次手术的患者占,8219%,，,20,年为,5525%,。再次手术的主要原因为二尖瓣进行性纤维化,风湿性二尖瓣返流重建手术的远期预后（29年）Methods,21,Carpentier-Edwards,环,132,65.7,口角成形术,106,52.7,腱索转移,23,11.4,腱索缩短,18,9,前叶延长术,14,7,后叶延长术,6,3,%,总修补人数,= 201,例患者,二尖瓣修补联合主动脉瓣置换治疗风湿性心脏病,Huynh-Quang Tri Ho, MD, Van-Phan Nguyen, MD, Kim-Phuong Phan, MD, Nguyen-Vinh Pham, PhD,Heart Institute, Ho Chi Minh City, Vietnam,MS 30% MR 37%Mixed 33%,死亡率,修补,1.4 %,置换,0.7 %,1,组中,9,年内无需再次二尖瓣手术者占,84.2 13%,，,2,组为,92 7.4% (log-rank test:,p,= 0.42),Carpentier-Edw,22,戊二醛,处理的自体心包补片瓣膜修补术治疗复杂性二尖瓣病变,Choi-Keung Ng, MD, Joachim Nesser, MD, Christian Punzengruber, MD, Otmar Pachinger, MD, Johannes Auer, MD, Herbert Franke, MD, and Peter Hartl, MD,Ann Thorac Surg 2001;71:7885,63,例患者超过,10,年,院内死亡率为,5,年内无再次手术, 95 %,技术,扩大,50 %,戊二醛0.625% - 30,分钟,6/0,或,7/0 Gore-Tex,缝线,戊二醛处理的自体心包补片瓣膜修补术治疗复杂性二尖瓣病变Ann,23,风湿性二尖瓣修补术后无再次手术患者的存活率,风湿性,MR,10,年无再次手术的存活率,85 90 %,风湿性联合瓣膜病变,10,年无再次手术的存活率,70 80 %,机械瓣膜,10,年无再次手术的存活率,90 95 %,风湿性二尖瓣修补术后无再次手术患者的存活率 风湿性 MR机械,24,第一次,MV,修补手术到再次手术的时间间隔,技术相关,= 6.04 7.18,瓣膜相关,= 45.44 33.65,手术相关的并发症,:,-,手术指征错误,严重的瓣膜疾病,瓣膜修补几率低,-,技术错误,修补技术不恰当,操作错误,-,第一次修补手术不完善,-,修补技术不稳定,瓣膜相关的并发症,:,-,疾病的自然进展,Vietnam,心脏中心,Prof. NV Phan,第一次MV修补手术到再次手术的时间间隔 技术相关 =,25,风湿性瓣膜病手术修补的技术要领,风湿性返流, 80 %,成功率,腱索增粗,开窗术或切除术,+,Gore-Tex,瓣叶缩短,心包补片,第二腱索松解术,瓣膜成形术,风湿性瓣膜病中瓣环扩张非常常见,口角成形术,风湿性联合瓣膜病变,成功率存在差异,腱索增粗,切除腱索,/PM,+ Gore-Tex,置换,腱索缩短,心包补片,第二腱索松解术,瓣膜成形术,心包补片技术能够使用更长的环,口角成形术,+,去除钙化,（,1,）瓣叶显著增厚或（,2,）双侧连合部钙化或（,3,）瓣环受限时应避免使用修补术,风湿性瓣膜病手术修补的技术要领风湿性返流 80 % 成功,26,香港大学二尖瓣置换,vs,修补,Gore-Tex,心包补片,香港大学二尖瓣置换 vs 修补 Gore-Tex心包补,27,环,.,何种环,?,一览表,环 . 何种环 ?一览表,28,房颤是一种严重的疾病,十年死亡率,Framingham,研究,62%,58%,30%,21%,Men,Women,不伴房颤,伴有房颤,24%,10%,2%,3%,50-59,60-69,70-79,80-89,房颤患者心梗的发生率,按年龄分组,房颤是一种严重的疾病十年死亡率62%58%30%,29,手术,- Maze,手术,手术 - Maze 手术,30,二尖瓣修补,二尖瓣修补 ,31,谢谢,谢谢,32,symptoms,symptoms,33,ESC 2007:,严重慢性器质性二尖瓣返流的手术指征,Eur Heart J 2007 28:230-268,有症状的患者伴,LVEF 30% and ESD 45 mm and/or LVEF 60 %),无症状的患者伴左心室功能正常，房颤或肺动脉高压,IaC,患者合并严重的左心室功能异常,(LVEF 55 mm),对药物治疗反映不佳，且能够修补的可能性高，死亡率较低,无症状的患者伴左心室功能正常，,IIbB,且能够修补的可能性,高，手术风险低,ESC 2007: 严重慢性器质性二尖瓣返流的手术指征 Eu,34,二尖瓣修补的方法东方的观点(中英文)课件,35,Mitral Valve Repair Strategies,Perspective EAST,Dr. Tim Wing-Kuk Au,FRCS , FHKCS,Consultant Surgeon,Honorary Clinical Assistant Professor,Department of Cardiothoracic Surgery,The University of Hong Kong,Queen Mary Hospital, Hong Kong SAR,New Horizon in Cardiovascular Treatments,December 2008 Shanghai, China,Cleveland Clinic,Mitral Valve Repair Strateg,36,Quantitative Determinants of the Outcomeof Asymptomatic Mitral Regurgitation,Maurice Enrique-Saran et al. N Engl J Med 2005;352:875-83,Quantitative Determinants of t,37,Facts about MR,Asymptomatic MR 5 - 10 years,Severe MR annual mortality 5 %,Sudden death in severe MR,Poor NYHA class,Low LV ejection,Atrial fibrillation,Severe MR (irrespective of etiology ),Surgery,Grigioni F. JACC 1999 34;7:2078-85,Otto C. N Engl J Med 2001, 345;10:740-6,Facts about MRAsymptomatic MR,38,Enrique-Saran et al. Circulation. 1994;90:830-37,Echocardiographic Prediction of Survival After Surgical Correction of Organic Mitral Regurgitation,Enrique-Saran et al. Circulati,39,Shuhaiber et al. Eur J Card Thorac Surg. 2007;31:267-75,Chords,Olivieria 1983,Survival,1.23,0.38,4.04,Chords,1.23,0.38,4.04,Degen,Gillinov 2003,Survival,1.67,1.30,2.15,Degen,Lee 1997,Survival,1.42,0.84,2.40,Degen,Mohty 2001,Survival,1.75,1.24,2.46,Degen,Yacoub 1981,Survival,2.34,0.91,6.05,Degen,1.68,1.39,2.02,Ischemic,Califiore 2004,Survival,0.78,0.19,3.16,Ischemic,Cohn 1995,Survival,0.53,0.18,1.53,Ischemic,Grossi 2001,Survival,1.34,0.92,1.95,Ischemic,Mantovani 2004,Survival,1.48,0.42,5.20,Ischemic,1.18,0.83,1.69,Mixed,Adebo 1984,Survival,1.48,0.33,6.70,Mixed,Akins 1994,Survival,1.60,0.76,3.36,Mixed,Craver 1990,Survival,1.16,0.39,3.50,Mixed,Enriguez-Sarano 99?,Survival,1.64,1.13,2.38,Mixed,Galloway 1989,Survival,1.55,1.02,2.35,Mixed,Hausmann 1999,Survival,0.86,0.58,1.26,Mixed,Kawachi 1991,Survival,4.33,0.64,29.34,Mixed,Perier 1984,Survival,2.39,1.30,4.37,Mixed,Sand 1987,Survival,1.63,1.04,2.57,Mixed,Thourani 2003,Survival,1.53,1.26,1.86,Mixed,1.49,1.24,1.78,Rheumatic,Antunes 1987,Survival,2.13,1.28,3.53,Rheumatic,Yau 2000,Survival,2.65,1.47,4.78,Rheumatic,2.33,1.59,3.43,Overall,1.58,1.41,1.78,Shuhaiber et al. Eur J Card Th,40,Repair,vs,Replacement,Superior hemodynamics,Preservation of ventricular function,Avoidance of prosthetic valve,Freedom from thromboembolism & bleeding,Lower infection rate,Skill and experience counts,Repair vs Replacement Supe,41,Type,Leaflet motion,Description,Ia,Normal,Annular dilatation,Ib,Leaflet perforation,IIa,Excessive,Chordal elongation,IIb,Chordal rupture,IIc,Papillary muscle,Infarction / elongation,IIIa,Restricted,Leaflet retraction or Commissural or chordal fusion,IIIb,Leaflet tethering by,LV dysf(x) or aneurysm,IV,Variable,Papillary muscle dysf(x),Carpentier Classification of Mitral Degenerative Regurgitation,TypeLeaflet motionDescriptionI,42,Mitral repair for degenerative diseases,Posterior leaflet - universal standard repair,Anterior leaflet more technical difficult and variable results,Commissural prolapse Carpentiers repair,Posterior leaflet Q resection,Anterior leaflet leaflet transfer,Mitral repair for degenerative,43,Artificial Chordae Gore-Tex 5/0,Artificial Chordae Gore-Tex,44,Results of degenerative MV repair West vs East,number,mortality,STS datebase,1.5 %,Gillinov 2008,3544,0.3 %,De Bonis 2006,738,0.3 %,Suri* 2006,64,1.6 %*,David 2005,701,0.7 %,Kasegawa 2006,181,1.3 %,Nakajima 2005,16,0.0 %,Cinghatanadgige 2003,43,2.3 %,Song 2003,184,1.0 %,Results of degenerative MV rep,45,Degenerative Mitral Regurgitation,East,=,West,Importance of TEE,Pitfalls of regurgitant jet direction,Saline jet test : yes or no,Barlows rare but difficult,Degenerative Mitral Regurgitat,46,Type,Leaflet motion,Description,Ia,Normal,Annular dilatation,Ib,Leaflet perforation,IIa,Excessive,Chordal elongation,IIb,Chordal rupture,IIc,Papillary muscle,Infarction / elongation,IIIa,Restricted,Leaflet retraction or Commissural or chordal fusion,IIIb,Leaflet tethering by,LV dysf(x) or aneurysm,IV,Variable,Papillary muscle dysf(x),Modified Carpentier Classification : Ischemic MR,TypeLeaflet motionDescriptionI,47,Mechanism of Ischemic Mitral Regurgitation - Chronic,Lveine et al. Circulation 112(5) August 745-58,Mechanism of Ischemic Mitral,48,Bursi, F. et al. Circulation 2005;111:295-301,Overall survival according to degree of MR in 773 patients who underwent echocardiography within 30 days after MI (solid line indicates no MR, dotted line mild MR, and dashed line moderate or severe MR),NIL MR,50,%,Mild MR,38,%,Mod or severe MR,12,%,Bursi, F. et al. Circu,49,How big is the problem in Asia,?,China National Center for Cardiovascular Disease 2005 Report :,Prevalence of IHD was 4.2% in the country,500,000 new cases of MI each year urban estimate,Estimated new cases severe Ischemic MR annually: 60,000,How big is the problem in Asia,50,In-hospital mortality,1.4 % repair vs 21 % replacement,P = 0.06,5 yr re-operation rate,repair 14 % vs replacement 3 %,P = 0.003,Mitral Repair Versus Replacement for Ischemic Mitral Regurgitation,Osman O. Al-Radi, MBBS, Peter C. Austin, PhD, Jack V. Tu, MD, Tirone E. David, MD, and Terrence M. Yau, MD, MS,In-hospital mortality 5 yr re-,51,Various Repair Techniques for Chronic Ischemic MR,Annuloplasty Undersized Bolling,(n=140),Carpentier methodsAcar,(n=44),2,nd,Chordae ReleasesDavid,(n=30),LV Restoration eg: DorsMericanti,(n=46),Relocation of Post. PMKron,(n=18),Edge-to-EdgeRepair Bhudia,(n=146)*,Various Repair Techniques for,52,Beijing,Shanghai,Year,1976 - 97,1978 - 03,Patients,4505,3416,Female (%),52.4,39.6,Age,40.5,40.0,Rheumatic (%),80,92,Mitral (%),54.3,100,Mechanical valve,100,100,Mortality (%),3.8,3.3,10 yr survival (%),93,94,Bleeding & thrombosis % patient.year,1.59,0.85,Mitral Valve Surgery review in China,Beijing ShanghaiYear 1976 - 97,53,Shuhaiber et al. Eur J Card Thorac Surg. 2007;31:267-75,Chords,Olivieria 1983,Survival,1.23,0.38,4.04,Chords,1.23,0.38,4.04,Degen,Gillinov 2003,Survival,1.67,1.30,2.15,Degen,Lee 1997,Survival,1.42,0.84,2.40,Degen,Mohty 2001,Survival,1.75,1.24,2.46,Degen,Yacoub 1981,Survival,2.34,0.91,6.05,Degen,1.68,1.39,2.02,Ischemic,Califiore 2004,Survival,0.78,0.19,3.16,Ischemic,Cohn 1995,Survival,0.53,0.18,1.53,Ischemic,Grossi 2001,Survival,1.34,0.92,1.95,Ischemic,Mantovani 2004,Survival,1.48,0.42,5.20,Ischemic,1.18,0.83,1.69,Mixed,Adebo 1984,Survival,1.48,0.33,6.70,Mixed,Akins 1994,Survival,1.60,0.76,3.36,Mixed,Craver 1990,Survival,1.16,0.39,3.50,Mixed,Enriguez-Sarano 99?,Survival,1.64,1.13,2.38,Mixed,Galloway 1989,Survival,1.55,1.02,2.35,Mixed,Hausmann 1999,Survival,0.86,0.58,1.26,Mixed,Kawachi 1991,Survival,4.33,0.64,29.34,Mixed,Perier 1984,Survival,2.39,1.30,4.37,Mixed,Sand 1987,Survival,1.63,1.04,2.57,Mixed,Thourani 2003,Survival,1.53,1.26,1.86,Mixed,1.49,1.24,1.78,Rheumatic,Antunes 1987,Survival,2.13,1.28,3.53,Rheumatic,Yau 2000,Survival,2.65,1.47,4.78,Rheumatic,2.33,1.59,3.43,Overall,1.58,1.41,1.78,Shuhaiber et al. Eur J Card Th,54,Type,Leaflet motion,Description,Repair technique,Ia,Normal,Annular dilatation,Annuloplasty,Ib,Leaflet perforation,IIa,Excessive,Chordal elongation,Gore-Tex or shortening,IIb,Chordal rupture,IIc,Papillary muscle,Infarction / elongation,Gore-Tex or shortening,IIIa,Restricted,Leaflet retraction or Commissural or chordal fusion,Pericardial patch,Commissuroplasty,Chordal, PM fenestration,IIIb,Leaflet tethering by,LV dysf(x) or aneurysm,IV,Variable,Papillary muscle dysf(x),Pathophysiology of Rheumatic Mitral Regurgitation,TypeLeaflet motionDescriptionR,55,Long-Term (29 Years) Results of Reconstructive Surgery in Rheumatic Mitral Valve Insufficiency,Sylvain Chauvaud, MD; Jean-Franois Fuzellier, MD; Alain Berrebi, MD; Alain Deloche, MD;Jean-Nol Fabiani, MD; Alain Carpentier, MD, PhD,Methods and Results,From 1970 to 1994, 951 patients with rheumatic MV insufficiency were operated on with the reconstructive techniques elaborated by Alain Carpentier. Mean age was 25.8 years (4 to 75), and sinus rhythm was present in 63%. The functional classification used was type I, normal leaflet motion, 71 patients (7%); type II, prolapsed leaflet, 311 patients (33%); and type III, restricted leaflet motion, 345 patients (36%). The combined lesion of prolapse of the anterior leaflet and restriction of the posterior was present in 224 patients (24%).,Surgical techniques used were implantation of a prosthetic ring in 95%, shortening of the chords and leaflet enlargement with autologous pericardium, and commissurotomy. Hospital mortality rate was 2%. The mean follow-up was 12 years (maximum, 29 years): 8618 patients per year. Actuarial survival was 89,19% at 10 years and 82,18% at 20 years. The rate of thromboembolic events was 0.4% patients per year (33 events), with 3 deaths. Freedom from reoperation was 82,19% at 10 years and 55,25% at 20 years. The main cause (83%) of reoperation was progressive fibrosis of the MV. The actuarial rate of reoperation was 2% patients per year and was correlated to the degree of preoperative fibrosis.,Long-Term (29 Years) Results o,56,Carpentier-Edwards ring,132,65.7,Commissurotomy,106,52.7,Chordal transfer,23,11.4,Chordal shortening,18,9,Anterior leaflet extension,14,7,Posterior leaflet extension,6,3,%,Total repair = 201 patients,Mitral Valve Repair with Aortic Valve Replacement in Rheumatic Heart Disease,Huynh-Quang Tri Ho, MD, Van-Phan Nguyen, MD, Kim-Phuong Phan, MD, Nguyen-Vinh Pham, PhD,Heart Institute, Ho Chi Minh City, Vietnam,MS 30% MR 37%Mixed 33%,Mortality,Repair 1.4 %,Replacement 0.7 %,Freedom from mitral,valve re-operation at 9 years was 84.2 13% for group,1 and 92 7.4% for group 2 (log-rank test:,p,= 0.42),Carpentier-Edw,57,Valvuloplasty With Glutaraldehyde-Treated Autologous Pericardium in Patients With Complex Mitral Valve Pathology,Choi-Keung Ng, MD, Joachim Nesser, MD, Christian Punzengruber, MD, Otmar Pachinger, MD, Johannes Auer, MD, Herbert Franke, MD, and Peter Hartl, MD,Ann Thorac Surg 2001;71:7885,63 patients over 10 years,Zero in-hospital mortality,5 yrs re-op free interval 95 %,Technique 50 % enlargement,Glutaldehyde 0.625% - 30 mins,6/0 or 7/0 Gore-Tex sutures,Valvuloplasty With Glutaraldeh,58,Re-operation Free Survival After Rheumatic Mitral Repair,Rheumatic MR,10 years re-op free survival 85 90 %,Rheumatic Mixed Mitral,10 years re-op free survival 70 80 %,Mechanical Prosthesis,10 years re-op free survival 90 95 %,Re-operation Free Survival Aft,59,Time Interval between Initial MV Repair and Reoperation,Procedure related = 6.04 7.18,Valve related = 45.44 33.65,Procedure related complication :,- Wrong indication severity of valve lesion,poorly likehood of valve repair,- Technical error unsuitable technique,wrong manipulation,- Inadequate initial repair,- Instability of repair technique,