Surgery for acquired valvular disease: results of mitral reconstructive surgery
Koie, H.; Kusuhara, K.; Miki, S.; Lee, T.H.; Matsumoto, M.; Ueda, Y.
Nihon Kyobu Geka Gakkai 29(7): 1109-1116
1981
ISSN/ISBN: 0369-4739 PMID: 7299201 Document Number: 178370
There is a growing tendency to recognize the efficacy of valvular reconstructive surgery. Among 151 consecutive patients with acquired valvular disease who underwent operation from Nov. 1973-April 1979 in Tenri Hospital [Japan], valvular reconstruction alone was performed on 108 patients without any early death; valve replacement was performed on 43 patients with 6 early deaths. Open mitral commissurotomy was performed on 99 patients. No patient with pure mitral stenosis was treated with mitral valve replacement. Postoperative study 1 mo. after commissurotomy revealed apparent hemodynamic improvement. Pulmonary capillary pressure dropped to 13.24 .+-. 5.05 mm Hg postoperatively from a preoperative level of 22.76 .+-. 7.27 mm Hg. Mitral valve area calculated from Gorlin's formula was 1.09 .+-. 0.50 cm2 preoperatively and 2.18 .+-. 0.79 cm2 postoperatively. The stroke index tended to increase postoperatively. The roles of papillary muscle division upon such hemodynamic improvement were then investigated. In 10 cases of open mitral commissurotomy in which papillary muscle was divided as deep as 5 mm or more, pulmonary capillary pressure dropped to 10.7 .+-. 3.02 mm Hg postoperatively from a preoperative level of 19.2 .+-. 6.55 mm Hg. Mitral valve area (Gorlin) markedly improved from 1.08 cm2 preoperatively to 2.53 cm2 postoperatively. By the left ventricular cineangiography, shapes of left ventricular cavity as well as the lengths of left ventricular short axis were studied at the end-diastolic and end-systolic stages. Distortion and immobility of the posterobasal area of the left ventricle as well as the decrease of left ventricular contraction improved in some patients after commissurotomy with division of papillary muscle. Evidently, valvular reconstructive surgery is now a safe and efficacious surgical procedure. Even with the rigid and highly stenotic mitral valve with markedly shortened chordae tendineae, satisfactory improvement may be obtained by dividing papillary muscle. dividing papillary muscle. This improvement may comprise of amelioration of not only valve function but also of left ventricular contraction and compliance.