Öz
Functional mitral regurgitation (MR) is usually caused by cardiomyopathy. Herein, we present chordal cutting and ring annuloplasty due to severely restricted anterior leaflet. Seventy-seven years old, male patient suffering shortness of breath had the diagnosis of severe mitral regurgitation and coronary artery disease. Preoperative echocardiography showed reduced ejection fraction and severe central
jet due to tethering of secondary chordae. Restricted chordae were resected by transverse aortotomy, saphenous graft bypass was done, and semi-rigid ring was implanted. Postoperative echocardiography showed no residual regurgitation, excellent mobility of anterior leaflet. Chordal cutting seems to be an effective technique to treat functional MR caused by the restriction of anterior leaflet
Anahtar Kelimeler
Functional mitral regurgitation chordal cutting mitral repair Functional mitral regurgitation, chordal cutting, mitral repair
Kaynakça
- Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017; 135 (25): e1159-e95.
- Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation. N Engl J Med. 2016; 374 (4): 344-53.
- Messas E, Guerrero JL, Handschumacher MD, et al. Chordal cutting: a new therapeutic approach for ischemic mitral regurgitation. Circulation. 2001; 104 (16): 1958-63.
- Girdauskas E, Pausch J, Harmel E, et al. Minimally invasive mitral valve repair for functional mitral regurgitation. Eur J Cardiothorac Surg. 2019; 55 (Supplement_1): i17-i25.
- McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004; 128 (6): 916-24.
- Kron IL, Green GR, Cope JT. Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation. Ann Thorac Surg. 2002; 74 (2): 600-1.
- Mihos CG, Xydas S, Yucel E, et al. Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies. J Thorac Dis. 2017; 9 (Suppl 7): S582-S94.
- Borger MA, Murphy PM, Alam A, et al. Initial results of the chordal-cutting operation for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2007; 133 (6): 1483-92.
- Murashita T, Okada Y, Kanemitsu H, et al. Midterm outcomes of chordal cutting in combination with downsized ring annuloplasty for ischemic mitral regurgitation. Ann Thorac Cardiovasc Surg. 2014; 20 (6): 1008-15.
- Drake DH, Zimmerman KG, Hepner AM, Nichols CD. Echo-guided mitral repair. Circ Cardiovasc Imaging. 2014; 7 (1): 132-41.
Öz
Fonksiyonel mitral yetmezlik sıklıkla kardiyomiyopatiye bağlıdır. Bu makalede, mitral anterior liflette ciddi restriksiyon nedeniyle kordal ayırma ve ring annüloplasti uygulanan hasta sunulmaktadır. Yetmiş yedi yaşında, erkek hasta, nefes darlığı şikâyeti ile tetkik edilip, ciddi mitral yetmezliği ve koroner arter hastalığı tanısı almıştır. Preoperatif ekokardiyografi’de sekonder kordadaki restriksiyona bağlı ciddi santral mitral yetmezlik jeti ve düşük sol ventrikül ejeksiyonu saptanmıştır. Restriktif kordalar transvers aortotomi ile mitral kapağa tutunduğu bölgeden kesilerek ayrıldı, safen ven grefti ile koroner baypas uygulandı ve mitral annülüse semi-rijid ring implante edildi. Postoperatif ekokardiyografi’de rezidü mitral kaçak gözlenmezken anterior liflet hareketinin gayet iyi olduğu görüldü. Kordal ayırma işlemi, özellikle anterior lifletin ciddi restriksiyonuna bağlı fonksiyonel mitral yetmezliği düzeltmek için uygulanabilecek etkin bir teknik gibi görünmektedir
Anahtar Kelimeler
Fonksiyonel mitral yetmezlik kordal ayırma mitral tamir. Fonksiyonel mitral yetmezlik, kordal ayırma, mitral tamir.
Kaynakça
- Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017; 135 (25): e1159-e95.
- Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation. N Engl J Med. 2016; 374 (4): 344-53.
- Messas E, Guerrero JL, Handschumacher MD, et al. Chordal cutting: a new therapeutic approach for ischemic mitral regurgitation. Circulation. 2001; 104 (16): 1958-63.
- Girdauskas E, Pausch J, Harmel E, et al. Minimally invasive mitral valve repair for functional mitral regurgitation. Eur J Cardiothorac Surg. 2019; 55 (Supplement_1): i17-i25.
- McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004; 128 (6): 916-24.
- Kron IL, Green GR, Cope JT. Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation. Ann Thorac Surg. 2002; 74 (2): 600-1.
- Mihos CG, Xydas S, Yucel E, et al. Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies. J Thorac Dis. 2017; 9 (Suppl 7): S582-S94.
- Borger MA, Murphy PM, Alam A, et al. Initial results of the chordal-cutting operation for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2007; 133 (6): 1483-92.
- Murashita T, Okada Y, Kanemitsu H, et al. Midterm outcomes of chordal cutting in combination with downsized ring annuloplasty for ischemic mitral regurgitation. Ann Thorac Cardiovasc Surg. 2014; 20 (6): 1008-15.
- Drake DH, Zimmerman KG, Hepner AM, Nichols CD. Echo-guided mitral repair. Circ Cardiovasc Imaging. 2014; 7 (1): 132-41.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Eylül 2022 |
| Gönderilme Tarihi | 10 Kasım 2021 |
| Yayımlandığı Sayı | Yıl 2022Cilt: 61 Sayı: 3 |
