演題

IS-1-1

Expanding indication of papillary muscle sandwich plasty from functional to organic mitral valve regurgitation

[演者] 石川 進:1
[著者] 三島 秀樹:1, 片山 康:1, 松永 裕樹:1, 大島 哲:1
1:東京都立墨東病院胸部心臓血管外科

Objentive. We have used an original papillary muscle heads approximation procedure, commonly known as a Sandwich plasty for the treatment of functional mitral regurgitation (MR) associated with ischemic cardiomyopathy (ICM) and aortic valve disease (AVD). We evaluated the availability of this method as the concomitant procedure for the plasty of organic MR.Patients & Methods. A Sandwich Plasty was used in 45 Functional MR (29 ICM and 16 AVD) patients and 11 Organic MR patients. In Organic MR patients, predominant cardiac diseases were solitary MR in six patients and combined valve diseases including aortic valve stenosis in five. Mitral valve changes included prolapse in six patients and moderate cusp thickening with calcification in five. Two heads of the papillary muscle connecting to the choldae of both the anterior and posterior leaflets are fixed with two Tefron-pledgeted 3-0 Ticron sutures..Results. After surgery, prominent MR was observed in a patient with Functional MR, however, residual MR was not detected in Organic MR patients. The tenting height (coaptation distance) of mitral valve significantly decreased after surgery from 11 to 7mm in Organic MR patients, which was similar to the results in Functional MR patients (from 12 to 7mm). The postoperative mean mitral orifice area in Organic MR patients was 4.3cm2 without stenosis.Conclusions. Sandwich plasty reduces the distance of choldae connecting to anterior and posterior leaflets and achieves the better coaptation of two leaflets. This procedure is simple and effective in the treatment of both Functional and Organic MR.
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