TOTAL CHORDAL APPARATUS VERSUS POSTERIOR MITRAL LEAFLET PRESERVATION IN MITRAL VALVE REPLACEMENT FOR RHEUMATIC MITRAL VALVE DISEASE IN SOUTH INDIAN POPULATION

Ravikrishnan Jayakumar, Varghese George

Abstract


BACKGROUND

            A fully functional mitral valve chordal apparatus with preserved annulo- ventricular continuity is important for the long term improvement of left ventricular function in patients undergoing mitral valve replacement. In this study, we compared the long term results of total mitral chordal apparatus preservation to posterior mitral leaflet preservation in South Indian patients undergoing mitral valve replacement in rheumatic mitral valve disease in terms of left ventricular ejection fraction (%) and left ventricular dimensions (mm).

MATERIALS AND METHODS

            190 patients of South Indian origin with rheumatic mitral valve disease, who underwent classical mitral valve replacement with St. Jude bileafelet mechanical valves, were divided into equal and comparable groups and included in this study. 91 (Group 1) had total mitral valve chordal apparatus preservation, 99 (Group 2) had posterior mitral leaflet preservation were used. All ventilated with minimal inotropic support and Amiodarone for fast ventricular rates. Follow up done by LVEF and LV dimensions assessment by 2D Echocardiography at 6 months and 2 years postoperative period.

RESULTS

            2 from Group 1 and 5 from Group 2 died of arrhythmias. Left ventricular ejection fraction for Group 1 pre-operatively, after 6 months & 2 years (43.46(5.13), 60.54(4.04) & 63.1(0.98)) showed improvement as compared to Group 2 (42.82(5.36), 50.2(4.84) & 54.15(4.43)). Left ventricular dimensions (end systolic/ end diastolic) for Group 1, pre-operatively, after 6 months & 2 years (55.62(2.77)/35.95(2.53), 40.06(2.48)/25.76(2.78) & 38.4(1.23)) was significantly better as to Group 2 (54.96(3.87)/35.81(2.12), 47.56(5.11)/29.72(4.6) & 44.3(7.48)/25.6(3.15)).

CONCLUSION

            Mitral valve replacement with total mitral chordal apparatus preservation had significant long term improvement of left ventricular ejection fraction and left ventricular dimensions as compared to posterior mitral leaflet preservation, in South Indian patients with rheumatic mitral valve disease.


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