ABSTRACT
Fifty-five patients with small aortic annuli underwent valve replacement either isolated or combined with other procedures. Patch enlargement of the aortic annulus in the area of the noncoronary sinus was used in 32 patients. The width of the patch was calculated by multiplying the desired increase in diameter by pi and adding 8 mm for suturing. The remaining 23 patients had aortic valve replacement with a prosthesis larger than the aortic annulus. The prosthesis was sutured in a supraannular position in the area corresponding to the noncoronary sinus. This slightly tilted position does not compromise function of Carpentier-Edwards or Björk-Shiley prostheses. Prosthetic gradients ranged from 0 to 18 mm Hg (9.2 +/- 3.9 mm Hg) in patients with patch enlargement of the aortic annulus and from 0 to 22 mm Hg (7.2 +/- 5.8 mm Hg) in patients with supraannular aortic prostheses. Although these techniques allow for insertion of prosthetic valves only one and two sizes larger than the aortic annulus, they appear to be satisfactory in most adult patients with a small aortic annulus.
Subject(s)
Heart Valve Prosthesis , Adult , Aged , Aortic Valve , Female , Hemodynamics , Humans , Male , Methods , Middle Aged , Prosthesis DesignABSTRACT
This study evaluates the possible role of the mitral apparatus in left ventricular function after correction of chronic mitral regurgitation. Seventeen patients underwent complete preoperative and early postoperative heart catheterization. Six patients underwent conventional mitral valve replacement (group 1), six mitral valve replacement with preservation of chordae tendineae and papillary muscles (group 2), and five mitral valvuloplasty (group 3). There was no statistically significant difference among the three groups for any hemodynamic parameter as compared before surgery by analysis of variance. After correction of mitral regurgitation the increase in cardiac index was similar for all three groups. Left ventricular end-diastolic volume did not decrease significantly in group 1 (p = NS), but it did in groups 2 and 3 (p less than .005 for both). Left ventricular end-systolic volume increased in group 1 (p less than .025) and decreased in groups 2 and 3 (p less than .01 and .005, respectively). Ejection fraction decreased in group 1 (p less than .005) and did not change in groups 2 or 3 (p = NS). Left ventricular end-diastolic pressure increased in group 1 (p less than .005) and decreased in groups 2 and 3 (p less than .01 for both). These findings suggest that continuity between mitral anulus and left ventricular wall through leaflets, chordae tendineae, and papillary muscles plays a role in left ventricular function after correction of the chronic mitral regurgitation.
