Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1983 Oct;38(10):730–736. doi: 10.1136/thx.38.10.730

Mitral valve annuloplasty: results in an underdeveloped population.

M J Antunes, R H Kinsley
PMCID: PMC459647  PMID: 6648851

Abstract

The long term results of mitral valve annuloplasty for pure mitral regurgitation are assessed. Thirty-three of the 100 patients (mean age 16 years) had acute rheumatic carditis at the time of operation. Three basic techniques were used: measured asymmetrical annuloplasty (Reed) in 37 patients, posterior plication annuloplasty in 56, Carpentier ring in seven. There were six early deaths, two of which were valve related. The mean follow up period for surviving patients was 4.8 (SD 1.2) years (range 3-9 years). Fourteen patients died late, all but one from valve related causes. Twenty-five had reoperation and all these had mitral valve replacement. The actuarial survival with initial repair was 56% at five years and 42% at eight years. Thirteen patients were lost to follow up. Of the remaining 42 patients, only 27 have an excellent or good clinical result. Eleven patients have only a satisfactory result, with a significant degree of residual or recurrent mitral regurgitation or disability or both. Possible causes of valve related failure were investigated; no significant difference was found between age groups or between acute and chronic cases. Poorer results, of statistical significance, were observed in patients in functional class IV and in those whose operation was performed on an emergency basis. No difference could be found between the results of the three techniques of mitral valve annuloplasty used. This retrospective study indicates that conservative procedures which are limited to annular repair produce inferior results. Valvuloplasty has many theoretical advantages which need practical confirmation.

Full text

PDF

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. Bonchek L. I. Correction of mitral valve disease without valve replacement. Am Heart J. 1982 Oct;104(4 Pt 1):865–868. doi: 10.1016/0002-8703(82)90023-0. [DOI] [PubMed] [Google Scholar]
  3. Bonchek L. I. Current status of cardiac valve replacement: selection of a prosthesis and indications for operation. Am Heart J. 1981 Jan;101(1):96–106. doi: 10.1016/0002-8703(81)90388-4. [DOI] [PubMed] [Google Scholar]
  4. Burr L. H., Krayenbühl C., Sutton M. S. The mitral plication suture: a new technique of mitral valve repair. J Thorac Cardiovasc Surg. 1977 Apr;73(4):589–595. [PubMed] [Google Scholar]
  5. 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]
  6. 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]
  7. Carpentier A., Dubost C., Lane E., Nashef A., Carpentier S., Relland J., Deloche A., Fabiani J. N., Chauvaud S., Perier P. Continuing improvements in valvular bioprostheses. J Thorac Cardiovasc Surg. 1982 Jan;83(1):27–42. [PubMed] [Google Scholar]
  8. 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]
  9. Copans H., Lakier J. B., Kinsley R. H., Colsen P. R., Fritz V. U., Barlow J. B. Thrombosed Björk-Shiley mitral prostheses. Circulation. 1980 Jan;61(1):169–174. doi: 10.1161/01.cir.61.1.169. [DOI] [PubMed] [Google Scholar]
  10. Davila J. C., Magilligan D. J., Jr, Lewis J. W., Jr Is the Hancock porcine valve the best cardiac valve substitute today? Ann Thorac Surg. 1978 Oct;26(4):303–316. doi: 10.1016/s0003-4975(10)62896-2. [DOI] [PubMed] [Google Scholar]
  11. Dubost C. Evaluation of surgery for mitral valve disease. Am Heart J. 1971 Aug;82(2):143–148. doi: 10.1016/0002-8703(71)90258-4. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. 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]
  14. EDWARDS J. E., BURCHELL H. B. Endocardial and intimal lesions (jet impact) as possible sites of origin of murmurs. Circulation. 1958 Nov;18(5):946–960. doi: 10.1161/01.cir.18.5.946. [DOI] [PubMed] [Google Scholar]
  15. Emery R. W., Nicoloff D. M. St. Jude Medical cardiac valve prosthesis: in vitro studies. J Thorac Cardiovasc Surg. 1979 Aug;78(2):269–276. [PubMed] [Google Scholar]
  16. Fowler N. O., van der Bel-Kahn J. M. Operations on the mitral valve: a time for weighing the issues. Am J Cardiol. 1980 Jul;46(1):159–162. doi: 10.1016/0002-9149(80)90618-9. [DOI] [PubMed] [Google Scholar]
  17. Geha A. S., Laks H., Stansel H. C., Jr, Cornhill J. F., Kilman J. W., Buckley M. J., Roberts W. C. Late failure of porcine valve heterografts in children. J Thorac Cardiovasc Surg. 1979 Sep;78(3):351–364. [PubMed] [Google Scholar]
  18. Grunkemeier G. L., Starr A. Actuarial analysis of surgical results: rationale and method. Ann Thorac Surg. 1977 Nov;24(5):404–408. doi: 10.1016/s0003-4975(10)63431-5. [DOI] [PubMed] [Google Scholar]
  19. Louw J. W., Kinsley R. H., Dion R. A., Colsen P. R., Girdwood R. W. Emergency heart valve replacement: an analysis of 170 patients. Ann Thorac Surg. 1980 May;29(5):415–422. doi: 10.1016/s0003-4975(10)61670-0. [DOI] [PubMed] [Google Scholar]
  20. McLaren M. J., Hawkins D. M., Koornhof H. J., Bloom K. R., Bramwell-Jones D. M., Cohen E., Gale G. E., Kanarek K., Lachman A. S., Lakier J. B. Epidemiology of rheumatic heart disease in black shcoolchildren of Soweto, Johannesburg. Br Med J. 1975 Aug 23;3(5981):474–478. doi: 10.1136/bmj.3.5981.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Moggio R. A., Hammond G. L., Stansel H. C., Jr, Glenn W. W. Incidence of emboli with cloth-covered Starr-Edwards valve without anticoagulation and with varying forms of anticoagulation. Analysis of 183 patients followed for 3 1/2 years. J Thorac Cardiovasc Surg. 1978 Feb;75(2):296–299. [PubMed] [Google Scholar]
  22. Morris D. C., King S. B., Douglas J. S., Jr, Wickliffe C. W., Jones E. L. Hemodynamic results of aortic valvular replacement with the porcine xenograft valve. Circulation. 1977 Nov;56(5):841–844. doi: 10.1161/01.cir.56.5.841. [DOI] [PubMed] [Google Scholar]
  23. REED G. E., TICE D. A., CLAUSS R. H. ASYMMETRIC EXAGGERATED MITRAL ANNULOPLASTY: REPAIR OF MITRAL INSUFFICIENCY WITH HEMODYNAMIC PREDICTABILITY. J Thorac Cardiovasc Surg. 1965 May;49:752–761. [PubMed] [Google Scholar]
  24. 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]
  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. Silver M. M., Pollock J., Silver M. D., Williams W. G., Trusler G. A. Calcification in porcine xenograft valves in children. Am J Cardiol. 1980 Mar;45(3):685–689. doi: 10.1016/s0002-9149(80)80022-1. [DOI] [PubMed] [Google Scholar]
  27. Spray T. L., Roberts W. C. Structural changes in porcine xenografts used as substitute cardiac valves. Gross and histologic observations in 51 glutaraldehyde-preserved Hancock valves in 41 patients. Am J Cardiol. 1977 Sep;40(3):319–330. doi: 10.1016/0002-9149(77)90153-9. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES