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Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair.

Guedes MA, Pomerantzeff PM, Brandão CM, Vieira ML, Tarasoutchi F, Spinola Pda C, Jatene FB - Rev Bras Cir Cardiovasc (2015 Jul-Sep)

Bottom Line: Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period.There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year.Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period.

View Article: PubMed Central - PubMed

Affiliation: Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, BR.

ABSTRACT

Introduction: Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce.

Objective: To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.

Methods: Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05.

Results: There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study.

Conclusion: Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.

No MeSH data available.


Related in: MedlinePlus

Intraoperative aspect of the mitral valve after completion of the mitral valverepair technique “Double Teflon”.We can observe the pledgets anchored in Teflon strips and the suture edge to edgeof the cusps.
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f01: Intraoperative aspect of the mitral valve after completion of the mitral valverepair technique “Double Teflon”.We can observe the pledgets anchored in Teflon strips and the suture edge to edgeof the cusps.

Mentions: This study was conducted at the Heart Institute, Hospital das Clinicas, Faculty ofMedicine, University of São Paulo for Heart Valve Surgery Unit and theEchocardiography Unit, with support from CEPEC (Echocardiography Research Center). Afterthe study was approved by the Ethics Committee of Hospital das Clinicas, Faculty ofMedicine, University of São Paulo and obtaining a written post-informed consent,between May/2006 and August/2008 we included 14 consecutive patients with mitralinsufficiency secondary to mitral valve prolapse of degenerative etiology, due toelongation or tendon chordal rupture related to the mitral valve posterior cusp, whounderwent mitral valve repair with the Double Teflon technique (Figure 1). Patients with associated valvular heart disease orsubmitted to previous heart surgery were excluded from the study. In this population,the age ranged between 39 and 75 years, with average of 61±11 years. Among allindividuals, 10 were male and 4 were female. The average weight and height of patientswas 75.6±10.9 kg and 1.69±0.1 m, respectively. Body surface area rangedbetween 1.64 and 2.10 m2, with a mean of 1.85±0.17 m2. Inthe investigation of personal history, 11 patients had hypertension; two patients haddiabetes mellitus, two from chronic renal failure requiring dialysis, three haddyslipidemia, and two had coronary artery disease. The additive EuroSCORE ranged between0 and 6, being that 11 cases presented additive EuroSCORE from 0 to 3 and the other 3cases showed additive EuroSCORE between 3 and 6. Regarding the functional class (FC) inthe preoperative period, one patient was in FC II, 12 in FC III and one in FC IV.


Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair.

Guedes MA, Pomerantzeff PM, Brandão CM, Vieira ML, Tarasoutchi F, Spinola Pda C, Jatene FB - Rev Bras Cir Cardiovasc (2015 Jul-Sep)

Intraoperative aspect of the mitral valve after completion of the mitral valverepair technique “Double Teflon”.We can observe the pledgets anchored in Teflon strips and the suture edge to edgeof the cusps.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541779&req=5

f01: Intraoperative aspect of the mitral valve after completion of the mitral valverepair technique “Double Teflon”.We can observe the pledgets anchored in Teflon strips and the suture edge to edgeof the cusps.
Mentions: This study was conducted at the Heart Institute, Hospital das Clinicas, Faculty ofMedicine, University of São Paulo for Heart Valve Surgery Unit and theEchocardiography Unit, with support from CEPEC (Echocardiography Research Center). Afterthe study was approved by the Ethics Committee of Hospital das Clinicas, Faculty ofMedicine, University of São Paulo and obtaining a written post-informed consent,between May/2006 and August/2008 we included 14 consecutive patients with mitralinsufficiency secondary to mitral valve prolapse of degenerative etiology, due toelongation or tendon chordal rupture related to the mitral valve posterior cusp, whounderwent mitral valve repair with the Double Teflon technique (Figure 1). Patients with associated valvular heart disease orsubmitted to previous heart surgery were excluded from the study. In this population,the age ranged between 39 and 75 years, with average of 61±11 years. Among allindividuals, 10 were male and 4 were female. The average weight and height of patientswas 75.6±10.9 kg and 1.69±0.1 m, respectively. Body surface area rangedbetween 1.64 and 2.10 m2, with a mean of 1.85±0.17 m2. Inthe investigation of personal history, 11 patients had hypertension; two patients haddiabetes mellitus, two from chronic renal failure requiring dialysis, three haddyslipidemia, and two had coronary artery disease. The additive EuroSCORE ranged between0 and 6, being that 11 cases presented additive EuroSCORE from 0 to 3 and the other 3cases showed additive EuroSCORE between 3 and 6. Regarding the functional class (FC) inthe preoperative period, one patient was in FC II, 12 in FC III and one in FC IV.

Bottom Line: Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period.There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year.Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period.

View Article: PubMed Central - PubMed

Affiliation: Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, BR.

ABSTRACT

Introduction: Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce.

Objective: To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.

Methods: Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05.

Results: There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study.

Conclusion: Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.

No MeSH data available.


Related in: MedlinePlus