Nakano M, Kurosawa H, Morita K, Nagahori R, Tatara A, Shimizu S
Department of Cardiac Surgery, Jikei University School of Medicine, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Sep;43(9):1617-24.
To evaluate the mitral reconstructive technique from the pathological and surgical points of view, 33 consecutive cases were analyzed. Eighteen patients (54.5%) were men, and the mean age was 40.9 +/- 19.8 (range 5 to 72 years). Ten patients (30.3%) had atrial fibrillation. The causes of mitral regurgitation were torn chordae tendinae in 17, elongated choradae tendinae in 14, annular dilatation in 8, papillary muscle dysfunction in 2, and congenital cleft in 4. The mitral regurgitation was due to prolapse of the anterior leaflet in 16, prolapse of the posterior leaflet in 10, and prolapse of both leaflets in 5. Resection and reconstruction of the leaflet was performed on anterior leaflet in 15, and on posterior leaflet in 15. The anterior mitral cleft was sutured in 3. The newly contrived wrapping and shortening chordoplasty was performed on anterior leaflet in 6, on posterior leaflet in 3, and on both leaflets in 2. Two patients had replacement of artificial chordae tendinae with EPTFE suture. Commissuroplasty was performed at anterolateral commissure in 5, at posteromedian commissure in 15, and at both commissures in 5. Thirty patients with dilated annulus underwent ring annuloplasty by Carpentier ring. There was no hospital death. Two patients required mitral valve replacement for redeveloping mitral regurgitation 2 weeks and one year after initial operation. All patients were in NYHA functional class I after surgery. The Doppler echo cardiographic study revealed no mitral regurgitation in 27, mild or trivial in 3, and moderate in 3. LVEDVI and LVESVI significantly decreased, and left ventricular volume overload was markedly reduced.
