Mitral valve replacement with maintenance of mitral annulopapillary muscle continuity in patients with mitral stenosis.

Postoperative left ventricular performance was evaluated in patients with mitral stenosis who underwent mitral valve replacement with maintenance of the continuity of the mitral anulus and papillary muscles. Mitral valve replacement with preservation of autologous chordae tendineae (n = 7) or their replacement with expanded polytetrafluoroethylene sutures (n = 14) was performed in 21 patients with mitral stenosis. Hemodynamic parameters were compared with those of 28 patients who underwent conventional mitral valve replacement and 27 patients who underwent open mitral valve commissurotomy. No deaths occurred in the early or late follow-up period. All hemodynamic parameters were improved after the operation, and no significant differences were detected among the three groups with regard to postoperative cardiac index or mitral valve area. No significant differences were observed in left ventricular end-diastolic volume index, end-systolic volume index, or contractility index, but the postoperative left ventricular ejection fraction in the chordal preservation and open commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative regional shortening was greatest at the diaphragmatic portion in the chordal preservation group and at the long axis in the open commissurotomy group. In the mid-term postoperative period, although no differences were noted among the three groups in echocardiographic data or global ejection fraction measured by multigated equilibrium radionuclide angiography, the regional shortening at the anterolateral portion of the left ventricle in the chordal preservation and commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative radionuclide angiography during exercise failed to demonstrate any difference between the ejection fraction in the chordal preservation group and that in the group having conventional mitral valve replacement.