Mitral Reconstruction Using Prosthetic Ring in Mitral Valvular Heart Disease

Na, Myung Hoon; Whang, Kyung Whan; Park, Kook Yang; Jung, Yoon Seup; Lee, Young Tak; Park, Young Kwan; Hong, Sung Nok

Abstract

Among 136 patients having undergone mitral valve surgery from September of 1994 through August of 1995 in Sejong Heart Institute, forty four patients(18 males, 26 females) underwent mitral valve reconstruction using prosthetic rings and their clinical results were evaluated. Patients' ages ranged from 5 to 63 years(mean age 38.2 years). Mitral valvular diseases were due to rheumatic origin in 30 patients(68 %), degenerative in 13(30%), and congenital in one patient(2%). Mitral regurgitation(MR) was in 33 patients(76%), mitral stenosis 2(5%), and mitral stenoinsufficiency 9 patients(19%). The patients were divided into Carpentier's functional groups : type I, 5 patients(11%) ; type II, 24 patients(55%) ; type III, 4 patients (9%) ; and mixed(II + III), 11 patients(25%). Average number of anatomic lesions of mitral valve per patient was 3.7. The techniques included prosthetic ring annuloplasty(44 patients, 32 Carpentier ring and 12 Duran ring), leaflet mobilization(24, 55%), chordae shortening(23, 52%), chordae trans- position(23, 52%), commissurotomy(16, 35%), leaflet resection(9, 20%), papillary muscle splitting(8, 18%), and chordae reimplantation(1, 2%). Average 3.4 surgical procedures were applied on mitral valve per patient. There were two hospital mortality and one reoperation due to development of MR(grade III) after 2 weeks. During the mean follow up of 12 months, patients improved in terms of functional class of the New York Heart Association, which was mean 3.0 preoperatively and 1.3 postoperatively. Doppler echocardiographic studies showed adequate valve area(2.07 +/- 0.11 cm2, mean +/- standard error), improved ventricular contractility in 41 patients(93%), absence of MR in 23(53%), trace MR in 18(42%), and grade II MR in 2 patients(5%).