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European Journal of Cardio-Thoracic Surgery, Vol 8, 478-481, Copyright © 1994 by European Association for Cardio-thoracic Surgery

ARTICLES

Effect of the preservation of annulo-papillary continuity on left ventricular ejection fraction after mitral valve replacement. A clinical randomized study on patients affected by rheumatic valve disease

G Tarelli, A Musazzi, F Semeraro, L Ceriani and E Respighi
Cardiochirurgia, Ospedale di Circolo, Centro R. Donatelli, Varese, Italy.

This perspective study has been designed to evaluate the modifications induced on left ventricular contractility by the interruption of annulo- papillary continuity during mitral valve replacement in patients with rheumatic valve disease. Patients with associated cardiac diseases were not admitted to the study. Sixty-nine patients entered the trial, each patient was randomly assigned to mitral valve replacement either with preservation of the annulo-papillary continuity (PAPC) or with excision of all the chordae (EC). Patients with mitral stenosis (MS) and combined mitral disease (MS & R) were considered separately. The four groups were similar regarding preoperative characteristics including the radioisotopic left ventricular ejection fraction (LVEF). All the patients had the mitral valve replaced with a bileaflet prosthesis fixed by interrupted mattress sutures in the supra-annular position; the methods of anesthesia, cardiopulmonary bypass and myocardial preservation were similar in all patients. In the patients of the two EC groups a complete excision of the mitral valve was performed. In the patients of the PAPC groups a modified Miki's technique was used to preserve annulo-papillary continuity; in eight cases with heavy calcification of the subvalvular apparatus, after total excision of the mitral valve, PTFE sutures were used to reconnect the annulus to the papillary muscles. After 6 months' follow-up, 2D and Doppler echocardiography was completed in each patient to confirm the absence of any prosthetic leakage and left ventricular outflow tract obstruction. (LVOT).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				R. Garcia-Fuster, V. Estevez, O. Gil, S. Canovas, and J. Martinez-Leon Mitral valve replacement in rheumatic patients: effects of chordal preservation. Ann. Thorac. Surg., August 1, 2008; 86(2): 472 - 481. [Abstract] [Full Text] [PDF]