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缺血性二尖瓣疾病患者的乳头肌修补手术 Papillary Muscle Repair Surgery in Ischemic Mitral Valve Patients (1.255 words) 冠状动脉疾病是65岁以上女性和45岁以上男性死亡的首要原因。冠状动脉疾病与缺血性瓣膜损害相互关连，由此降低了术后长期存活性。然而，继发于缺血性心脏病的二尖瓣返流药物治疗效果不佳，死亡率明显增高，并且手术死亡率也显著增加。然而，尽管大多数医生主张修补，但是自从不明机制的导致瓣膜关闭不全被认知后， 缺血性瓣膜病就被瓣膜替换手术所取代。 Coronary artery disease is the leading cause of death in women aged over 65 years and men aged over 45 years. The association of coronary artery disease with organic non-ischemic valve lesions has been linked to decreased postoperative long-term survival. However, mitral valve regurgitation secondary to ischemic heart disease unfavorably alters prognosis for medical therapy, carries a significant mortality, and is also associated with a dramatically increased surgical mortality. Nevertheless, although most surgeons advocate and prefer repair, ischemic valves are often replaced by them, since the mechanism that causes the otherwise intact valve to leak is normally not understood. 自从1956年，由Walther Lillehei完成第一例二尖瓣瓣膜成形环手术，和1968年，由Allan Carpentier进行的第一例二尖瓣用假体环成形手术后，二尖瓣手术在近些年已经逐步的完善了。然而，缺血性二尖瓣返流患者仍然是具有挑战性的一个手术。二尖瓣手术和冠状动脉血运重建术相结合的手术，有报告指出手术效果不佳，围手术期有19%－53%死亡率。并且采取修补这种方法仍在讨论中。 我们已经开展并采用一个新的手术技术， 当缺血和/或梗死导致乳头肌纤维退化和延长，从而导致继发的瓣叶脱垂这种情况发生时 ,乳头肌缩短成形术可以治疗缺血性二尖瓣返流这种特殊的病理。 Mitral valve surgery has subsequently evolved through the years, since 1956, when the first mitral annyloplasty was performed by Walther Lillehei, and 1968, when the first mitral valve reconstruction using a prosthetic ring was performed by Allan Carpentier. However, patients with ischemic mitral regurgitation still represent a surgical challenge. The results after combined mitral procedures and coronary revascularization with a reported perioperative mortality of 19-53% have been poor, and the optional methods of repair are still under discussion. We have developed and employed a new surgical technique, a papillary shortening plasty for this specific pathology of ischemic mitral regurgitation, when ischemia and/or infarction has resulted in fi