Left ventricular function after mitral valve repair versus mitral valve replacement with chordal preservation: a comparative prospective study

This study included 26 patients. Two patients died during the postoperative period, 4 were lost for follow up and complete follow up data are available for the 20 patients. Patients were randomized preoperatively into two groups: Group A included 12 patients with mitral valve repair and group B included 8 patients with mitral valve replacement with chordal preservation. All patients had severe chronic mitral incompetence. The age of these patients ranged from 12 to 38 years [mean +/- SD 23.2 +/- 8.3 years]. Four patients were males and the remaining 16 patients were females. Echo was used to estimate left ventricular dimensions, percentage fractional shortening, ejection fraction, end systolic stress and the ratio between it and end systolic volume index. Ring annuloplasty using Carpentier ring was used in all repair patients and the posterior leaflet and its chordae was preserved in all patients with mitral valve replacement. The duration of stay in ICU, cardiopulmonary bypass time, the anoxic time, need for inotropic support, time to extubation, presence of residual incompetence and the functional class after. From the results, it was concluded that left ventricular function is prone to deterioration after both mitral valve repair and replacement. Deterioration in left ventricular function was more pronounced after mitral valve replacement with chordal preservation rather than mitral valve repair. Disruption of the papillary mitral loop is the most plausible explanation for the worse left ventricular function after mitral valve replacement with chordal preservation

Balloon dilatation for coarctation of the aorta in children and adults: short and intermediate term results

Twenty patients aged 5ms. to 33 years with unoperated aortic coarctation [CoA], underwent percutaneous balloon dilatation between March 1987 and April 1990. Pre- and post-dilatation pressures, proximal and distal to the coarctation as well as aortography in the AP and LAO views were obtained. One balloon was used in 14 patients whereas 2 balloons were used in two. The balloon diameter used was 20% less than the aortic diameter just above the diaphgram. Balloon length varied between 40-80 mms. Before dilatation the peak systolic gradient [PSO] ranged from 45-l60 mmHg., with a mean of 75 mmHg. The mean systolic gradient ranged from 20-70 with a mean of 38mmHg. Post-dilatation PSO dropped to 0-60 with a mean of 3mmHg. Aortography revealed a substantial increase in the diameter at the site of CoA in all patients and decrease of collaterals. Clinical and radiologic follow-up showed no evidence of restenosis or aneurysm formation. Pressure measurement and aortography done 6-12 months after dilatation in 4 patients, showed no restenosis or aneurysm formation. No intraprocedural complications were encountered. However the first patient developed infective endarteritis and dissection at the site of CoA which mandated surgical interference. Femoral artery obstruction occured in two patients; temporary in one and necessitating thrombendarterectomy in the other. Early and intermediate results suggest that balloon dilatation offers an effective and safe non-surgical alternative for the treatment of discrete CoA in children and adults. However long term follow .up will ultimately determine the efficacy and safety of this procedure