Abstract

Objectives: We evaluated the results of rheumatic mitral valve replacement with preservation of subvalvular apparatus.

Patients and Methods: Mitral valve replacement, isolated or in combination with other procedures, was performed in 36 patients (31 females, 5 males; mean age 37.7±14 years; range 14 to 66 years) between January 1996 and 2000. Mitral insufficiency alone or in combination with mitral stenosis was present in 44.4% and 50%, respectively. Concomitant procedures were performed in 44% for associated cardiac lesions. Subvalvular apparatus was preserved in all patients by different techniques. Posterior leaflet was retained in 27 patients, anterior leaflet was retained in one patient, both anterior and posterior leaflets were retained in eight patients. The follow-up period ranged between 13 to 16 months.

Results: NYHA classification score was 2.61±0.54 preoperatively and 1.63±0.76 postoperatively (p<0.05). Left ventricular end diastolic diameter and left atrial diameter decreased at the end of the postoperative first year. Mortality, valvular thrombosis, or left ventricular outflow obstruction were not observed during the follow-up period.

Conclusion: Some reconstructive techniques can be performed in patients with severe rheumatic mitral stenosis and regurgitation. However, a second operation, usually mitral valve replacement, is required after some period in most of these patients.This condition brings an additional economical burden and an operational risk to the patient, as well. Therefore, whenever repair techniques are not sufficient due to advanced disease, we recommend mitral valve replacement with preservation of subvalvular apparatus.