Initial experience in valvuloplasty for mitral valve disease at Ain-Shams University, Cairo

ABSTRACT

From Feb., 1989, through Dec., 1990, 47 patients with mitral valve disease [mean age 31 +/- 18 years] were subjected to comperehensive mitral valvuloplasty. Twenty-eight patients had pure or predominant regurgitation. Mitral valve insufficiency was due to rheumatic disease in 42 patients [89%] and degenerative disease in 5 [11%]. The patients were divided into three functional groups type I [normal leaflet motion], groups leaflet motion], 5 patients [11%]; type II [leaflet prolapse], 28 patients [49%]; and type III [restricted leaflet motion], 14 patients [30%]. Almost all patients [80.5%] were in New York Heart Association Functional Class III or IV and 20% had atrial fibrillation. The techniques used included commissurotomy with or without splining of chordae and/ or papillary muscle [24 patients], shortening plasty of anterior leaflet chordae tendineae [15 patients], resection of secondary, tertiary, and basal posterior leaflet chordae [15 patients], prosthetic ring annuloplasty [8 patients], quadrangular resection of mural leaflet with sliding leaflet technique [8 patients], transposition of chordae [6 patients], and sliding plasty of papillary muscles [5 patients], anterior transposition of posterior papillary muscle [1]. Additional procedures were performed in 29 patients including tricuspid repair in 19 and aortic valve replacement in 10. Valve function after valvuloplasty was assessed clinically and echocardiographically. Eighty-four percent of the patients had a good immediate result. Current operative mortality is 4.25%, and no late mortality. Reoperation was required in two patients [4.25%], mostly in the first three months. Neither thromboembolism nor infective endocarditis were present. There have been no late recurrences of insufficiency. Mitral vavuloplasty is an excellent alternative to valve replacement in patients with mitral valve disease