title: Interrupted commissural band annuloplasty prevents mitral stenosis.
abstract: BACKGROUND
  Mitral annuloplasty is an important component of the treatment of degenerative mitral valve disease. However, postoperative echocardiography reveals elevated mitral gradients in some patients. We developed a technique that we termed interrupted commissural band annuloplasty (iCBA), which does not shorten either the anterior or posterior annulus and is not associated with the development of a mitral gradient. We compared the echocardiographic characteristics of patients treated using this method versus Cosgrove ring (COS) placement, both at rest and during exercise.
  
  
  METHODS
  ICBA features placement of three sutures in the commissures using two bands and shortens the commissural annular length by 60 %. We used this method to treat 63 patients and placed Cosgrove bands in 58. Of all patients, 48 who underwent iCBA and 34 with COSs passed the exercise echocardiographic test.
  
  
  RESULTS
  The maximal transmitral pressures at rest in the iCBA and Cosgrove groups were 8.04 ± 0.74 and 11.30 ± 0.88 mmHg (P = 0.0029), respectively, and the mean transmitral pressures at rest were 2.46 ± 0.74 and 3.61 ± 0.32 mmHg (P = 0.0037), respectively. The maximal transmitral pressures during exercise were 11.79 ± 0.97 and 18.37 ± 1.16 mmHg (P < 0.0001), and the mean transmitral pressures during exercise were 4.95 ± 0.45 and 7.76 ± 0.53 mmHg (P < 0.0001).
  
  
  CONCLUSIONS
  ICBA prevents postoperative mitral stenosis both at rest and importantly during exercise.
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan. sawamasa7007bb@nifty.com.
authors.forename: Masaru
authors.initials: M
authors.lastname: Sawazaki
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Tomari
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Zaikokuji
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Imaeda
mesh_terms: D000368:Aged; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000503:physiopathology / Q000517:prevention & control*; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Exercise test; Mitral stenosis; Mitral valve repair