[Valve replacement with chordal preservation and valvuloplasty for chronic mitral insufficiency].
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.
Dancini
José Luiz
JL
Instituto do Coração, Hospital das Clínicas, FM, USP. jluiz1003@uol.com.br
Pomerantzeff
Pablo Maria Alberto
PM
Spina
Guilherme Sobreira
GS
Pardi
Mírian Magalhães
MM
Giorgi
Maria Clementina Pinto
MC
Sampaio
Roney Orismar
RO
Grinberg
Max
M
Oliveira
Sérgio Almeida de
SA
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