Plastica mitral com anel maleável de pericárdio bovino / Mitral valve repair with a malleable bovine pericardium ring

ABSTRACT

OBJECTIVE: To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and echodopplercadiographic results. METHODS: Thirty-two (25 female and 7 male) patients, aged between 9 and 66 (M=36.4 + or - 17.2) years, were studied over a 16-month period, with 100 percent follow-up. In 23 (72 percent) of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus. RESULTS: The patient survival ratio was 93.8 percent, with 2 (6.2 percent) fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On echodopplercardiography, 88 percent of the patients had functional recovery of the mitral valve (50 percent without and 38 percent with mild insufficiency and no hemodynamic repercussions). Of four (12 percent) of the remaining patients, 6 percent had moderate and 6 percent had seigre insufficiency. Twenty-eight percent of class II patients and 72 percent of class III patients passed into classes I (65 percent), II (32 percent), and III (3 percent), according to NYHA classification criteria. CONCLUSION: Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures: