Echocardiographic evaluation of patients undergoing mitral valve replacement with crossed papillopexy.
BACKGROUND
Techniques for mitral valve replacement with preservation of the subvalvular apparatus have proven their superiority, and crossed papillopexy is a new technical option which, besides allowing Preservation of the anatomical structures, provides contractility support and protection to the myocardium during ventricular diastole. The technique requires further studies that document its results.


OBJECTIVE
To evaluate the left atrial and ventricular function by Doppler echocardiography in patients who have undergone mitral valve replacement with crossed papillopexy.


METHODS
Fifteen patients underwent mitral valve replacement, 9 (60%) of them male, and the mean age was 45.7 years. As to the etiology of aortic valve disease, nine (60%) cases were degenerative, three (20%) were rheumatic, two (13.3%) were ischemic, and one patient (6.7%) had infectious endocarditis. After closure of the atriotomy and anatomical evaluation of the valvar apparatus, the anterior leaflet was detached from the annulus and centrally split in halves, each one with its complex tendinous chords attached to the opposing commissure by its medial extremity. Biological (13 cases) or mechanical prosthetic valves were implanted and secured with separate stitches. Reduction of the valvar annulus was performed in patients with dilated cardiomyopathy. Patients underwent clinical and Doppler echocardiographic examinations before surgery and six months after the procedure.


RESULTS
All patients were clinically stable at discharge. A significant reduction in ventricular and atrial diameters was demonstrated (p< 0.001) without impairment of the entry and exit points of the left ventricle.


CONCLUSIONS
Mitral valve replacements performed with the crossed papillopexy technique showed favorable results with a positive effect on the recovery of left atrial and ventricular morphology.
Santa Casa de Misericórdia de Goiânia, Goiânia, GO, Brasil. gpaulino@cardiol.br
Geraldo Paulino
GP
Santana Filho
Otoni Moreira
OM
Gomes
Gilson José de
GJ
Oliveira
Débora
D
Rodrigues
Ana Cláudia
AC
Nogueira
Rômulo
R
Sales
Delzirene Botelho
DB
Pinheiro
Antonio Calzada
AC
Machado
Nivaldo Gomes
NG
Oliveira
D000293:Adolescent; D000328:Adult; D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult