Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1983 Aug;38(8):565–571. doi: 10.1136/thx.38.8.565

Conservative surgery for mitral valve disease: clinical and echocardiographic analysis of results.

O A Adebo, J K Ross
PMCID: PMC459612  PMID: 6612646

Abstract

Eighty-five patients underwent mitral valve reconstruction by the Carpentier method from January 1976 to December 1981. Concomitant procedures were performed in 30 patients (aortic valve replacement in 23, coronary revascularisation in six, and tricuspid valve repair in seven). Before operation 76 patients (89%) were in clinical class II or III (New York Heart Association) and atrial fibrillation was present in 50. Thirty-six patients had valvular incompetence, while 26 had pure stenosis. The aetiology was rheumatic in 57 cases and dysplastic in 21. The patients were assessed for clinical improvement, durability of valve repair, thromboembolism, and survival. There was one death, an operative mortality rate of 1.2%, and 63 of 74 patients followed for one to six years were in clinical class I after operation. The actuarial survival was 92% with a 93% incidence of freedom from thromboemboli at five years. Six patients had embolic episodes, four of whom had aortic valve replacement. Three patients had a repeat operation 16-20 months later, a valve failure rate of 6.7%. Nineteen patients with ruptured chordae had postoperative echocardiographic assessment of myocardial and mitral valve functions; the peak rates of dimension changes of the left ventricular cavity (indicative of flow across the mitral valve) fell to normal in most patients, and the left ventricular end-diastolic dimensions decreased significantly from 6.4 (1.53) to 5.09 (1.31) cm (mean and SD)--p less than 0.05. Our results confirm that reconstructive mitral surgery is able to restore and maintain normal valve function in addition to providing satisfactory relief of symptoms.

Full text

PDF
565

Images in this article

566Image
on p.566

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Björk V. O., Henze A. Ten years' experience with the Björk-Shiley tilting disc valve. J Thorac Cardiovasc Surg. 1979 Sep;78(3):331–342. [PubMed] [Google Scholar]
  2. Borkon A. M., McIntosh C. L., Von Rueden T. J., Morrow A. G. Mitral valve replacement with the Hancock bioprosthesis: five- to ten-year follow-up. Ann Thorac Surg. 1981 Aug;32(2):127–137. doi: 10.1016/s0003-4975(10)61019-3. [DOI] [PubMed] [Google Scholar]
  3. Burggraf G. W., Craige E. Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery. Am J Cardiol. 1975 Apr;35(4):473–480. doi: 10.1016/0002-9149(75)90829-2. [DOI] [PubMed] [Google Scholar]
  4. Carpentier A., Chauvaud S., Fabiani J. N., Deloche A., Relland J., Lessana A., D'Allaines C., Blondeau P., Piwnica A., Dubost C. Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg. 1980 Mar;79(3):338–348. [PubMed] [Google Scholar]
  5. Carpentier A., Deloche A., Dauptain J., Soyer R., Blondeau P., Piwnica A., Dubost C., McGoon D. C. A new reconstructive operation for correction of mitral and tricuspid insufficiency. J Thorac Cardiovasc Surg. 1971 Jan;61(1):1–13. [PubMed] [Google Scholar]
  6. Carpentier A., Relland J., Deloche A., Fabiani J. N., D'Allaines C., Blondeau P., Piwnica A., Chauvaud S., Dubost C. Conservative management of the prolapsed mitral valve. Ann Thorac Surg. 1978 Oct;26(4):294–302. doi: 10.1016/s0003-4975(10)62895-0. [DOI] [PubMed] [Google Scholar]
  7. Clark R. D., Korcuska K., Cohn K. Serial echocardiographic evaluation of left ventricular function in valvular disease, including reproducibility guidelines for serial studies. Circulation. 1980 Sep;62(3):564–575. doi: 10.1161/01.cir.62.3.564. [DOI] [PubMed] [Google Scholar]
  8. Duran C. G., Pomar J. L., Revuelta J. M., Gallo I., Poveda J., Ochoteco A., Ubago J. L., Cohn L. H. Conservative operation for mitral insufficiency: critical analysis supported by postoperative hemodynamic studies of 72 patients. J Thorac Cardiovasc Surg. 1980 Mar;79(3):326–337. [PubMed] [Google Scholar]
  9. Duran C. G., Ubago J. L. Clinical and hemodynamic performance of a totally flexible prosthetic ring for atrioventricular valve reconstruction. Ann Thorac Surg. 1976 Nov;22(5):458–463. doi: 10.1016/s0003-4975(10)64454-2. [DOI] [PubMed] [Google Scholar]
  10. Gibson D. G., Brown D. Measurement of instantaneous left ventricular dimension and filling rate in man, using echocardiography. Br Heart J. 1973 Nov;35(11):1141–1149. doi: 10.1136/hrt.35.11.1141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gibson D. G. Estimation of left ventricular size by echocardiography. Br Heart J. 1973 Feb;35(2):128–134. doi: 10.1136/hrt.35.2.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Halseth W. L., Elliott D. P., Walker E. L., Smith E. A. Open mitral commissurotomy. A modern re-evaluation. J Thorac Cardiovasc Surg. 1980 Dec;80(6):842–848. [PubMed] [Google Scholar]
  13. Ionescu M. I., Smith D. R., Hasan S. S., Chidambaram M., Tandon A. P. Clinical durability of the pericardial xenograft valve: ten years experience with mitral replacement. Ann Thorac Surg. 1982 Sep;34(3):265–277. doi: 10.1016/s0003-4975(10)62496-4. [DOI] [PubMed] [Google Scholar]
  14. LILLEHEI C. W., GOTT V. L., DEWALL R. A., VARCO R. L. The surgical treatment of stenotic or regurgitant lesions of the mitral and aortic valves by direct vision utilizing a pump-oxygenator. J Thorac Surg. 1958 Feb;35(2):154–191. [PubMed] [Google Scholar]
  15. Laschinger J. C., Cunningham J. N., Jr, Baumann F. G., Isom O. W., Catinella F. P., Mendelsohn A., Adams P. X., Spencer F. C. Early open radical commissurotomy: surgical treatment of choice for mitral stenosis. Ann Thorac Surg. 1982 Sep;34(3):287–298. doi: 10.1016/s0003-4975(10)62498-8. [DOI] [PubMed] [Google Scholar]
  16. Laschinger J. C., Cunningham J. N., Jr, Baumann F. G., Isom O. W., Catinella F. P., Mendelsohn A., Adams P. X., Spencer F. C. Early open radical commissurotomy: surgical treatment of choice for mitral stenosis. Ann Thorac Surg. 1982 Sep;34(3):287–298. doi: 10.1016/s0003-4975(10)62498-8. [DOI] [PubMed] [Google Scholar]
  17. Mary D. A., Pakrashi B. C., Wooler G. H., Ionescu M. I. Study with reflected ultrasound of patients with mitral valve repair. Br Heart J. 1973 May;35(5):480–487. doi: 10.1136/hrt.35.5.480. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Nair K. K., Yates A. K. Direct evaluation of mitral valve function during surgery following conservative procedures. J Thorac Cardiovasc Surg. 1977 May;73(5):684–685. [PubMed] [Google Scholar]
  19. Oury J. H., Peterson K. L., Folkerth T. L., Daily P. O. Mitral valve replacement versus reconstruction. An analysis of indications and results of mitral valve procedures in a consecutive series of 80 patients. J Thorac Cardiovasc Surg. 1977 Jun;73(6):825–835. [PubMed] [Google Scholar]
  20. Pombo J. F., Troy B. L., Russell R. O., Jr Left ventricular volumes and ejection fraction by echocardiography. Circulation. 1971 Apr;43(4):480–490. doi: 10.1161/01.cir.43.4.480. [DOI] [PubMed] [Google Scholar]
  21. Reed G. E., Pooley R. W., Moggio R. A. Durability of measured mitral annuloplasty: seventeen-year study. J Thorac Cardiovasc Surg. 1980 Mar;79(3):321–325. [PubMed] [Google Scholar]
  22. Schuler G., Peterson K. L., Johnson A., Francis G., Dennish G., Utley J., Daily P. O., Ashburn W., Ross J., Jr Temporal response of left ventricular performance to mitral valve surgery. Circulation. 1979 Jun;59(6):1218–1231. doi: 10.1161/01.cir.59.6.1218. [DOI] [PubMed] [Google Scholar]
  23. Scott-Jupp W., Barnett N. L., Gallagher P. J., Monro J. L., Ross J. K. Ultrastructural changes in spontaneous rupture of mitral chordae tendineae. J Pathol. 1981 Mar;133(3):185–201. doi: 10.1002/path.1711330303. [DOI] [PubMed] [Google Scholar]
  24. Sherrid M. V., Clark R. D., Cohn K. Echocardiographic analysis of left atrial size before and after operation in mitral valve disease. Am J Cardiol. 1979 Feb;43(2):171–178. doi: 10.1016/s0002-9149(79)80001-6. [DOI] [PubMed] [Google Scholar]
  25. Shore D. F., Wong P., Paneth M., Buckley M. J. Results of mitral valvuloplasty with a suture plication technique. J Thorac Cardiovasc Surg. 1980 Mar;79(3):349–357. [PubMed] [Google Scholar]
  26. St John Sutton M. G., Traill T. A., Ghafour A. S., Brown D. J., Gibson D. G. Echocardiographic assessment of left ventricular filling after mitral valve surgery. Br Heart J. 1977 Dec;39(12):1283–1291. doi: 10.1136/hrt.39.12.1283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Teply J. F., Grunkemeier G. L., Sutherland H. D., Lambert L. E., Johnson V. A., Starr A. The ultimate prognosis after valve replacement: an assessment at twenty years. Ann Thorac Surg. 1981 Aug;32(2):111–119. doi: 10.1016/s0003-4975(10)61017-x. [DOI] [PubMed] [Google Scholar]
  28. Thomas R. D., Mary D. A., Ionescu M. I. Echocardiographic pattern of posterior mitral valve leaflet movement after mitral valve repair. Br Heart J. 1979 Apr;41(4):399–404. doi: 10.1136/hrt.41.4.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. WOOLER G. H., NIXON P. G., GRIMSHAW V. A., WATSON D. A. Experiences with the repair of the mitral valve in mitral in competence. Thorax. 1962 Mar;17:49–57. doi: 10.1136/thx.17.1.49. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES