title: Mitral valve replacement with crossed papillopexy and annular constriction in heart failure patients.
abstract: OBJECTIVE
  To analyze the short-term and mid-term follow-ups of patients with heart failure and moderate to severe mitral valve insufficiency and who have undergone mitral valve replacement with crossed papillopexy and annular constriction.
  
  
  METHODS
  Thirteen patients in NYHA functional class III or IV, with a mean age of 54.1 years and with idiopathic etiology, underwent mitral valve replacement with ring constriction and crossed papillopexy. Echocardiograph parameters, functional class and survival actuarial curve were analyzed.
  
  
  RESULTS
  There were no deaths during surgery or in the postoperative period. The mean left ventricular diastolic diameter was reduced from 71 +/- 8.6 mm to 65.3 +/- 8.6 mm (p=0.049) and the mean left ventricular systolic diameter was reduced from .1 +/- 8.5 mm to 50.4 +/- 11.1 mm (p=0.002). The atrial diameters varied from 49.4 +/- 6.4 mm to 44 +/- 5.9 mm (p=0.017); the percentage of the left ventricular shortening was 17 +/- 4 % to 24 +/- 8.3% (p=0.014); the ejection fraction varied statistically and significantly from 34 +/- 9% to 45 +/- 14% (p=0.008). Eleven (84.6%) patients were in FC I and II. At 1, 6 and 12 months after follow-up surgery, the survival rate was 100%, 82.6%, 71.6%, respectively. This rate was maintained at 7.6% for more than 36 months.
  
  
  CONCLUSIONS
  The results obtained from patients with heart failure and moderate to severe mitral valve insufficiency and who underwent mitral valve replacement with crossed papillopexy and annular constriction presented evidence of improved heart remodeling and significant improvement in left ventricular performance.
authors.affiliation: Cardiothoracic Surgery, UFMS. ricardobenfatti@gmail.com
authors.forename: Ricardo Adala
authors.initials: RA
authors.lastname: Benfatti
authors.forename: José Carlos Dorsa Vieira
authors.initials: JC
authors.lastname: Pontes
authors.forename: Otoni Moreira
authors.initials: OM
authors.lastname: Gomes
authors.forename: Amaury Edgardo Mont'serrat Avila Souza
authors.initials: AE
authors.lastname: Dias
authors.forename: Jandir Ferreira
authors.initials: JF
authors.lastname: Gomes Júnior
authors.forename: Neimar
authors.initials: N
authors.lastname: Gardenal
authors.forename: João Jackson
authors.initials: JJ
authors.lastname: Duarte
mesh_terms: D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D010210:Papillary Muscles / Q000601:surgery*; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology