Surgical treatment of mitral valve deformity

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Mitral valve lesions due to valve replacement must be accounted for about 10 of the number of cases to 15%. Operation: the median sternotomy

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Mitral valve lesions due to valve replacement must be accounted for about 10 of the number of cases to 15%. Operation: the median sternotomy incision, through the right atrial incision into the inferior vena cava into the blood vessels, in the vicinity of the innominate artery opening to dispose of the ascending aorta intubation. The cardiopulmonary bypass was established, and the body temperature was reduced to about 25 DEG C. The aorta was cut off, and the left atrium was incised in the sulcus of the room to determine the pathological changes of the mitral valve, with particular attention to the activity of the leaflet and the appearance of the flap, tendon and papillary muscles. When the operation function of injection of saline water helps to determine the mitral valve pressure in left ventricular cavity can reach leaflet closure line and mitral annulus after flap in leaf base are parallel, and two leaflets on the surface more, it may be considered that the valve has obtained satisfactory correction of deformity. Congenital mitral stenosis valve repair: according to the specific conditions of valve lesions for plastic surgery.

Leaflet: leaflet perforation with pericardial patches can be mended and leaflet cleft for suture. Junctional fusion. Tendinous cords: long tendons can be implanted into the papillary muscles. The chordae deletion of the segment was part of losing the support of the leaflet, then sewing sympetalous leaves and valve ring. The tendon space is covered by the flap tissue or the tendon is too thick, so that it can be used to repair the fenestration of the tendon, and the free edge of the free flap of the tendon is sutured to the adjacent tendon.

Papillary muscle: papillary muscle is too long or only a large papillary muscle, can be part of the incision of the papillary muscles or perform papillary muscle fenestration.

Valve ring: valve ring is too large to make the ring suture or ring with artificial valve ring plasty. Mitral ring: resection of left atrial wall along the fiber ring but must pay attention not to damage the anterior leaflet.

After resection of mitral valve replacement: using cervical expander gently expand the valve ring, only the valve prosthetic valve into the column and the ring sewing suture in the left atrial wall, so you can choose a larger diameter artificial valve. Results: in patients with mitral stenosis, the mortality rate was 25 to 40%. The operative mortality of patients with mitral regurgitation was only 3 ~ 10%. In the case of mitral valve replacement surgery mortality rate was 20 ~ 60%, mitral regurgitation was 30%. Although more than half of the left atrial and left ventricle still had residual diastolic pressure difference or apical systolic murmur, but nearly 90% of the cases recovered to I.

 

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