Ciddi restriksiyonu olan mitral anterior liflet için kordal ayırma

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.

Chordal cutting for severely restricted mitral anterior leaflet

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.

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