[Mitral valve replacement with preservation of the posterior leaflet, chordae tendineae and papillary muscles (modified MVP)].

The modified MVR leaving the posterior leaflet and its subvalvular tissues intact was performed in 40 patients including 17 of MR, 17 of MSR and 6 of MS from 1981 to 1984 in this institution. Mitral valves were replaced mostly with mechanical valves and using interrupted everting mattess sutures. Moreover, the aortic valve was simultaneously replaced in 13 patients and the tricuspid valve was also treated with annuloplasty, commissurotomy or replacement in 11 patients. There were no hospital deaths and 3 late deaths caused by MOF or unknown cause. Left ventricular rupture as a fatal complication did not occur. High cardiac index and LVSWI with low left atrial pressure were maintained in the immediate postoperative period. Q-d times at the base, mid portion and apex of the left ventricle were measured by 2-D echocardiograms in the follow-up period and were compared with those of patients with conventional MVR. Those at apex and mid portion were significantly shorter in patients with modified MVR than in patients with conventional MVR. These findings suggest that the left ventricular contraction might be maintained better in the former than in the latter. In conclusion, preservation of the posterior leaflet, chordae tendineae and papillary muscles should be preferable in MVR for prevention of both LOS and left ventricular rupture.