Midterm Results of Mitral Valve Repair with a Rigid Ring / 日本心臓血管外科学会雑誌

The purpose of this study was to analyze our results of mitral valve repair with a rigid annuloplasty ring (Carpentier-Edwards ring; Baxer-Edwards CVS Laboratories; Lrvine, Calif) in terms of its efficacy and safety. We have examined postoperative mitral regurgitation (MR) and left ventricular diastolic dimension (LVDd) in 63 cases of mitral valvoplasty during a period of 5 years. The operative methods were 20 cases of tendon reconstruction, 42 cases of quadrangular resection, and 15 cases of annuloplasty alone. Operative mortality and freedom from complications were examined at the mean 41.2 months after the operation. There were no operative deaths, and no case with severe MR postoperatively. From echocardiographic findings, the grade of MR changed from 3.13 to 0.28 postoperatively, and LVDd changed from 58.4±6.71 to 48.7±6.3ml postoperatively. Reoperation was performed in 2 cases (3.2%) several years after the first operation. The rate of midterm mortality was 4.8%. The postoperative mitral valve area was 2.85cm² in size of 26mm ring, 2.95cm² in size of 28mm, 3.09cm² in size of 30mm, which were measured from PHT (pressure half time) of the Doppler echocardiography. In conclusion, mitral valve repair with rigid annuloplasty ring (CE ring) provided good results for MR at midterm follow-up.

Mitral Valve Repair for Infectious Endocarditis / 日本心臓血管外科学会雑誌

Between January 1999 and August 2002, 13 patients with mitral regurgitation resulting from native valve endocarditis underwent surgery. The age of these patients was 54±13.8 years (range, 27 to 74 years); 8 patients were men. Five patients were categorized as New York Heart Association functional class III or IV. Endocarditis was active in 3 patients. Emergency or urgent surgery was required in 4 patients. Twelve patients underwent repair, and one had a valve replacement. Following the removal of all infected or nonviable tissue, a decision was made as to the possibility of repair. Repair was attemped in 13 patients and was successful in 12 patients. Most patients received ring annuloplasty with a Carpentier-Edward ring. Six patients had chordae ruptures, 5 patients had vegetations, and 2 patients had elongated chordae. Twelve patients were categorized as New York Heart Association functional class I, and one was categorized as class II at discharge. There were no hospital deaths. The mean follow-up of the 13 survivors was 24±14 months (range from 3 to 43 months). There were no late deaths, reoperations, recurrent endocarditis, thromboembolic events, or other valve-related morbidities. We conclude that mitral valve repair is an effective treatment for inective endocarditis with mitral regurgitation.