[Preservation of the entire mitral subvalvular apparatus during mitral valve replacement in patients with mitral stenosis].
OBJECTIVE
To evaluate the surgical technique and the effect of preservation of the entire mitral subvalvular apparatus during mitral valve replacement (MVR) in patients with mitral stenosis.


METHODS
MVR was performed on 56 patients with mitral stenosis. Of them, 11 had complete preservation of the entire mitral subvalvular apparatus (group A) with the technique of preservation of 'button-shaped' transplantation, 25 had the preservation of the posterior leaflet only (group B), and the other 20 underwent the conventional MVR (group C). Pre- and postoperative hemodynamic parameters were measured to determine the left ventricular performance. Echocardiography was performed preoperatively, at the time of discharge, and 3 to approximately 6 months postoperatively to determine the dimensions and ejection function.


RESULTS
Cardiac index, stroke volume index and left ventricular stroke work index postoperatively in group A were better than those in group B and C (P < 0.05). Echocardiographic measurements postoperatively showed the increase of LVESD, LVEDD in group B and C, but a better LVL and LVFS in group A (P < 0.05), and LVEF was more pronounced in group A (P < 0.05). There appeared a long cross-clamp time in group A, but the total CPB time was not significant among the three groups.


CONCLUSIONS
The surgical skills of preservation with 'button-shaped' transplantation may be a practical choice for patients with mitral stenosis. The preservation of entire mitral subvalvular apparatus improves the left ventricular functions after MVR in patients with mitral valve stenosis.
Chen
Sheng-xi
SX
Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Xi
Er-ping
EP
Zhang
Wei-xing
WX
D000293:Adolescent; D000328:Adult; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left