Abstract： Compared with mitral valve replacement, there areseveral advantages in mitral valvuloplasty, so recently more and more sights are caught on mitral valve repair. According to different etiology, the surgeon can apply annuloplasty, triangular resection, quadrangular resection, replacement or transposition of chordae tendineae and so on to treat mitral regurgitation(MR). With the development of minimally invasive surgical technology, robotic mitral valve reconstruction evolve rapidly and percutaneous interventional therapy also commence from lab to bedside.We believe surgeons can repair MR safely and successfully in the majority of patients with proficiency in the basic techniques.
ObjectiveTo evaluate outcomes of mitral valvuloplasty with artificial chord and mitral annuloplasty ring in patients with mitral valve prolapse. MethodsFrom January 2012 to March 2014, mitral valvuloplasty with artificial chord and mitral annuloplasty ring were performed for 58 patients with mitral valve prolapsed in Department of Cardiovascular Surgery, Fujian Provincial Hospital, among which 47 simple anterior or posterior mitral valvuloplasty and 11 combined anterior-posterior mitral valvuloplasty were completed. There were 33 males and 25 females aged (53.7±14.3) years. ResultsThere was no in-hospital death. Three patients received mitral valve replacement. The transoesophageal echocardiography found no or trivial mitral regurgitation in 48 patients, mild mitral regurgitation in 7 patients. The diameter of the left atrium (LA) and left ventricle (LV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were significantly decreased after the operation. During the follow-up of 6 months to 2 years, the cardiac function of the patients improved. ConclusionMitral valvuloplasty with artificial chord and mitral annuloplasty ring is simple, reliable and effective treatment for patients with mitral valve prolapse, and its shortand mid-term outcome is good.
Abstract： Objective To evaluate the effect of a surgical method for treating mild- to moderate-ischemic mitral regurgitation（IMR） using a self-designed device during off-pump coronary artery bypass grafting（OPCAB）. Methods From September 2009 to August 2011, six patients（4 males, 2 females； age was 52-73 years） with mild- to moderate-IMR underwent OPCAB and concomitant mitral valvuloplasty using a self-designed device in Beijing An Zhen Hospital. Their degree of IMR, anteroposterior diameter of mitral annulus, left ventricular long-axis diameter, left ventricular short-axis diameter and left ventricular spherical index（left ventricular short-axis diameter/left ventricular long -axis diameter）were measured using transesophageal Doppler echocardiography before and after mitral valvuloplasty. Their mean aorta pressure, mean pulmonary artery pressure and central venous pressure were also measured via Swan-Ganz catheter before and after mitral valvuloplasty. Perioperative cardiac function indexes were compared. Results There was no in-hospital death. IMR of all patients disappeared postoperatively. After mitral valvuloplasty their anteroposterior diameter of mitral annulus（3.43±0.08 cm vs.3.68±0.08 cm；t=5.430, P=0.001）, left ventricular short-axis diameter（4.80±0.21 cm vs.5.53±0.11 cm；t=7.530, P=0.001）and left ventricular spherical index（0.64±0.02 vs.0.74±0.01；t=11.110, P=0.002）significantly decreased than those before mitral valvuloplasty . But their left ventricular long-axis diameter and hemodynamic indexes did not change significantly after mitral valvuloplasty. All the six patients were followed up at the out-patient department 3 months postoperatively without autonomous symptoms. Their heart function improved to I class（New York Heart Association）. Echocardiography showed 4 patients without IMR and 2 patients with trace of minimalIMR. Conclusion Off-pump surgical therapy for mild- to moderate- IMR during OPCAB can help the patients reverseremodeling of the left ventricle, avoid the risks of cardiopulmonary bypass and improve cardiac function with good short-term effects. This method may be a good choice for treating patients with IMR.
Abstract: Objective To summarize the clinical results of homemade flexible annuloplasty ring in mitral valve repair, in order to discuss the appropriate ring size. Methods Sixtysix patients (55 males,and 11 females with a mean age of 44.62±15.94 years) with mitral insufficiency underwent mitral valve repair with homemade flexible annuloplasty ring from April 2002 to November 2009 in Fu Wai Hospital. In order to choose the ring with an appropriate size, we made and kept to the following principles: if the intercommissural distance was bigger than size 30, we chose a ring 2size smaller; if the measured distance was smaller than size 30, 1size smaller ring would be chosen. Patients were followed by echocardiography to observe the mitral valve function. Results All patients were cured and discharged from the hospital. The results of echocardiography showed mild to moderate regurgitation in 1 patient, mild regurgitation in 11 patients, and normal mitral function or trace regurgitation in the rest 54 patients. Mitral valve forward velocity was 1.40±0.30 m/s with no mitral stenosis or systolic anterior motion (SAM) of the anterior mitral leaflet. Fiftyone patients were followed up from 2 months to 7 years(24.60±25.90 months). The results of echocardiography on 38 patients showed that 1 patient had moderate regurgitation, 5 patients had mild to moderate regurgitation, 9 patients had mild regurgitation and others had normal mitral function or trace regurgitation. For these 38 patients included in the followup study, mitral valve forward velocity was 1.50±0.40 m/s with no mitral stenosis, SAM or left ventricular outlet tract obstruction. During the followup, the left atrium size (43.19±10.48 mm vs. 48.59±9.40 mm, t=4.524, P=0.000) and left ventricular end diastolic diameter (52.64±7.35 mm vs. 6269±8.77 mm, t=7.607, P=0.000) decreased significantly than the preoperative size and diameter respectively. The application of restrictive homemade flexible annuloplasty ring in mitral valve annuloplasty had satisfactory, durable and stable clinical results.
ObjectiveTo investigate clinical outcomes of mitral valvuloplasty (MVP)for the treatment of infective endocarditis (IE)and mitral regurgitation (MR). MethodsFrom March 2002 to January 2012, 33 patients with IE and MR underwent MVP in Fu Wai Hospital. There were 23 male and 10 female patients with their age of 10-67 (35.7±17.8)years. Thirteen patients had previous cardiac anomalies. Preoperatively, there were 5 patients with mild MR, 15 patients with moderate MR and 13 patients with severe MR. There were 5 patients in New York Heart Association (NYHA)functional classⅠ, 23 patients in classⅡ, 4 patients in classⅢ and 1 patient in classⅣ. All the patients received MVP including 14 patients received MVP in active phase of IE. Concomitantly, 6 patients received aortic valve replacement, 5 patients received tricuspid valvuloplasty, 1 patient received coronary artery bypass grafting, 1 patient received resection of left atrial myxoma and 1 patient received repair of aortic sinus aneurysm. Surgical procedures included pericardial patch closure of leaflet perforation in 5 patients, leaflet excision and suturing in 17 patients, double-orifice method in 3 patients, chordae transfer and artificial chordae implantation in 5 patients, and annuloplastic ring implantation in 15 patients. ResultsOne patient died of acute myocardial infarction 7 days after the operation. All other 32 patients were successfully discharged. Echocardiography before discharge showed left ventricular end-diastolic diameter (LVEDD, 48.9±7.6 mm)and left atrial diameter (LAD, 31.7±7.4 mm)were significantly smaller than preoperative values (P=0.000). Thirty-two patients were followed up for 6-125 (73.0±38.6)months. There was no death, IE recurrence, bleeding or thromboembolism during follow-up. One patient received mitral valve replacement for mitral stenosis 3 years after discharge. There were 25 patients in NYHA func-tional classⅠ, 5 patients in classⅡand 2 patients in classⅢ. There were 4 patients with mild MR, 1 patient with moderate MR, and 26 patients had no MR. One patient had faster mitral inflow at diastolic phase (1.7 m/s). One patient had moderate aortic regurgitation. LVEDD and LAD during follow-up were not statistically different from those before discharge. Left ventricular ejection fraction during follow-up was significantly higher than that before discharge (60.9%±6.6% vs. 57.5%±6.7%, P=0.043). ConclusionMVP is a reliable surgical procedure for patients with IE and MR, and can significantly reduce left atrial and left ventricular diameter and improve cardiac function postoperatively.
ObjectiveTo evaluate the effectiveness of mitral valve repair for mitral regurgitation. MethodsWe retrospectively analyzed the clinical data of 47 patients underwent mitral repair in General Hospital of Ningxia Medical University between January 2010 and June 2014 year. There were 36 males and 11 females with age of 10 months to 65 years, mean age of 42.38±15.27 years. ResultsThere was no operative death within follow-up time of 18±7 months (ranged 14 to 1 586 days). Mitral valve function was normal or traces regurgitation in 33 patients (70.21%). Mild mitral regurgitation occurred in 11 patients (23.40%). Postoperative transesophageal echocardiography showed that 2 patients (4.26%) had moderate regurgitation. They underwent mitral valve repair again and cured. One patient (2.13%) underwent mitral valve replacement because of moderate to severe regurgitation. The dimensions of left atrium and left ventricle obviously decreased and heart function improved significantly compared with preoperative ones. ConclusionStrict control of surgical indications for different valve disease, the use of mitral valve repair technique, mitral surgery can get a good clinical efficacy. Preoperative diagnosis by transesophageal echocardiography, intraoperative monitoring, and immediate postoperative assessment for mitral valve repair results provide good technical support.
Objective To explore the safety and complications of repeated sternotomy after mitral valve repair and prevention strategies. Methods We retrospectively analyzed the clinical data of 88 consecutive patients of non-rheumatic mitral valve disease who underwent repeated sternotomy for failure of first-time mitral valve repair in our hospital from January 2009 through June 2015. There were 53 males and 35 females with a mean age of 36.1±17.5 years in the patients who underwent repeated sternotomy. Meanwhile 88 patients who underwent the first-time sternotomy for mitral valve repair simultaneously were randomly recruited as a control group, and there were 57 males and 31 females with a mean age of 39.9±12.6 years. The clinical outcomes were analyzed retrospectively and compared between the two groups. Results No major injury was observed in the patients who underwent repeated sternotomy. Eight patients (9.1%) in the repeated sternotomy group required femoral artery cannulation. Cardiopulmonary bypass (CPB) time was longer in the femoral artery cannulation group than that in the aortic cannulation group (155.5±59.0 minvs. 119.5±39.9 min,P=0.023). While there was no statistical difference in aortic cross-clamp time (P=0.786). Eight patients (9.1%) in the repeated sternotomy group used extra-pericardium approach. There was no significant difference in CPB time (P=0.255) or aortic cross-clamp time (P=0.360) between the patients who used extra-pericardium approach and those used routine approach. There was no statistical difference in post-operative complications between the patients who used different sternotomy strategies. Although CPB time (123.0±3.0 minvs. 95.4±37.1 min,P=0.000) or aortic cross-clamp time (79.0±36.3 minvs. 67.5±29.1 min,P=0.026) was longer in the repeated sternotmy group, the major outcomes were similar between the repeated sternotmy group and the first-time sternotmy group (P＞0.05). Conclusion Repeated sternotomy after mitral valve repair is relatively safe. With appropriate strategies, repeated sternotomy is not associated with increased risk of operative morbidity.