Mitral Valve Replacement with Chordal Preservation in Mitral Stenotic Disease / 대한흉부외과학회지

BACKGROUND: Mitral valve replacement with chordal preservation in patients with mitral regurgitation has been proved to be beneficial for left ventricular function and for reduction of postoperative complication. However, in patients with mitral stenosis, the effectiveness of the technique is controversial. It is not easy to insert prosthetic valve without left ventricular outflow tract obstruction and prosthetic valve leaflet motion hinderance. MATERIAL AND METHOD: Five patients with mitral stenosis and seven patients with mitral stenoinsufficiency underwent mitral valve replacement with preservation of mitral subvalvular apparatus. Thickened and calcified leaflets are made thin by peeling off the thickened and calcified part. Commissurotomy was done and anterior leaflet was incised 2 mm apart from the annulus and then divided into two segments. Anterolateral and posteromedial segments including strut chordae, were reattached to mitral commissural area, respectively. RESULT: There was no evidence of prosthetic valve dysfunction, paravalvular leakage, left ventricular outflow tract obstruction, complications and operative or late deaths. CONCLUSION: We conclude that mitral vlave replacement with chordal preservation was safe and effective technique for the patients with mitral stenotic disease.

The Effect of Chordae Preservation in Mitral Valve Replacement / 대한흉부외과학회지

BACKGROUND: Mitral valve replacement(MVR) with chordal preservation in patients with mitral vlavular disease has been proven to be beneficial for left ventricular function and for reduction of postoperative complication. MATERIAL AND METHOD: From January 1995 to July 1996, the early postoperative results of mitral valve replacement were compared between 20 patients who underwent chordae resection(classic MVR group) and 10 patients who underwent chordae preservation(preservation MVR group) in the Department of Thoracic and Cardiovascular Surgery, Chunbuk National University Hospital. RESULT: There was no significant difference between the two groups in age, sex, NYHA functional class, cardiothoracic ratio, echocardiographic finding, cardiopulmonary bypass time and aortic cross clamping time. The difference between preoperative and postoperative cardiothoracic ratio after 3 months was not statistically significant. At echocardiographic left ventricular evaluation, ejection fraction and fractional shortening decreased slightly in the preservation group then preoperative value (p=0.47, p=0.12), however, decreased significantly in the classic MVR group(p=0.03, p=0.04), and were statistically significant between the two groups(p=0.03, p=0.02). CONCLUSION: We conclude that MVR with chorda preservation seems to have a beneficial effect on postoperative left ventricular performance in mitral valve disease than the classic MVR.