title: [Valve replacement with chordal preservation and valvuloplasty for chronic mitral insufficiency].
abstract: OBJECTIVE
  To compare, from the clinical and laboratory points of view, 3 groups of patients undergoing surgical treatment for isolated chronic mitral insufficiency. One group underwent valvuloplasty, and the other 2 groups underwent mitral valve replacement with different techniques for chordal preservation.
  
  
  METHODS
  Twenty-eight patients with a mean age of 54.1 years, no coronary or multivalvular disease, and no reoperation, underwent surgery as follows: 9 underwent valvuloplasty; 10 underwent mitral valve replacement with chordal preservation in both leaflets; and 9 underwent mitral valve replacement with chordal preservation only in the posterior leaflet. Clinical, Doppler echocardiographic, and radionuclide ventriculographic assessments were performed until the 6th month of follow-up.
  
  
  RESULTS
  At the end, 88.8% of the patients were in functional class I. One died due to intracranial hemorrhage during anticoagulant treatment. The left ventricular diastolic diameter (P<0.0001) and end-diastolic volume (P<0.0001) decreased in the 3 groups. Only the patients undergoing valvuloplasty had a decrease in systolic diameter (P=0.0003) and in end-systolic volume (P=0.0040), with no change in the ejection fraction (P=0.5586). The patients undergoing mitral valve replacement had a similar drop in ejection fraction (P=0.0001 and P=0.0296).
  
  
  CONCLUSIONS
  The 3 surgical techniques used provided clinical improvement. Patients undergoing valvuloplasty had better preservation of ventricular function. No significant difference was observed in cardiac performance between the 2 groups undergoing mitral valve replacement with chordal preservation within a 6-month follow-up.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, FM, USP. jluiz1003@uol.com.br
authors.forename: José Luiz
authors.initials: JL
authors.lastname: Dancini
authors.forename: Pablo Maria Alberto
authors.initials: PM
authors.lastname: Pomerantzeff
authors.forename: Guilherme Sobreira
authors.initials: GS
authors.lastname: Spina
authors.forename: Mírian Magalhães
authors.initials: MM
authors.lastname: Pardi
authors.forename: Maria Clementina Pinto
authors.initials: MC
authors.lastname: Giorgi
authors.forename: Roney Orismar
authors.initials: RO
authors.lastname: Sampaio
authors.forename: Max
authors.initials: M
authors.lastname: Grinberg
authors.forename: Sérgio Almeida de
authors.initials: SA
authors.lastname: Oliveira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002815:Chordae Tendineae / Q000601:surgery*; D002908:Chronic Disease; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000592:standards; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome; D014655:Vascular Resistance