Remote Results after Mitral Valve Replacement

Aim of investigation is to research properties of patients at remote period after mitral valve replacement (MVR). At ana-lyzed group are included 634 patients with mitral valve diseases, which were treated by MVR in National Amosov Institute of cardiovascular diseases from 1st January 2005 to 1st January 2007. Average being of research was 7.3 ± 0.9 years. Following values of research at 10-year step: survival 69.4%, stability of good results – 57.3%, freedom from thromboembolic events – 79.7%, freedom from reoperations – 95.4%. Plasty of LA was performed in 57 (10.1%) patients. Maze procedure was oc-cured in 39 (6.9%) patients. Concomitant tricuspid malformation (TV annuloplasty) was observed in 135 (23.7%) patients. Concomitant CABG was observed in 93 (5.0%) patients. Previous heart surgery (mainly closed mitral commissurotomy) had 129 (21.4%) patients. Reoperations were occured: thromboses (panus, paraprost. fistula) of mitral prostheses (n = 5), endocarditis (n = 3). AV blockade (pacemaker) was occured in 9 (1.6%) patients. Best results of mitral valve replacement were observed in remote period in patients at II–III NYHA class with presence of sinus rhythm. Patients must be followed-up with tightly observation especially risk group–IV functional class, atrial fibrillation, concomitant tricuspid valve diseases, left atriomegaly (diameter of 6.0 cm or more), ejection fraction less than 0.45, high pulmonary hypertension (PASP > 70 mmHg), CABG + progressive ischemic heart disease, left ventriculomegaly (ESVI > 95 ml/mq), female, age more than 60 years. Mitral valve replacement with operation Maze allows successfully renew sinus rhythm on a hospital stage, and stabilize it well during half-year after operation.

Per-operative Changes of Pulmonary Artery Pressure following Closed Mitral Commissurotomy

Background: Mitral stenosis is often present with pulmonary hypertension. Closed Mitral Commissurotomy (CMC) is a treatment of choice for severe mitral stenosis. In this study, we examined the per-operative changes of pulmonary artery pressure following opening of stenosed mitral valve. Methods: All these CMCs were performed routinely through the left antero-lateral thoracotomy (4th intercostal space) and dilatation was done by metallic Tubb’s Dilator. Peroperative left atrial and Pulminary Arterial pressures were measured before and after dilatation. Results: 15 patients had undergone CMC. Following CMC, per-operative mean Pulmonary artery pressure was reduced from 45.5±7.1 mm of Hg to 39.0±8.8 mm of Hg (p=0.043). Mean left atrial pressure reduced from 35.9±5.6 mm of Hg to 30.0±9.1 mm of Hg (p = 0.049). At three months follow up after closed mitral commissurotomy mitral valve area at echocardiography was found 2.29±0.18 cm2. There was no case of death after closed mitral commissurotomy. Mild mitral regurgitation occurred in 1 patient. Conclusion: We conclude that there is immediate significant reduction of pulmonary Artery pressure following closed mitral commissurotomy. This reduction is apparently comparable with a similar reduction of left atrial pressure. Cardiovasc. j. 2019; 11(2): 147-151

Mitral Valve Replacement After 10 Years of Closed Mitral Commissurotomy: A Case Report

Rheumatic mitral valvular heart disease is common in developing countries although its incidence is decreasing in western countries. Closed mitral commissurotomy (CMC) was the first effective intervention in valvular heart disease which provides excellent long-term hemodynamic and clinical improvement. In this study we are presenting a successful mitral valve replacement in reoperation of a case who had CMC operation 10 years ago. It shows when symptomatic deterioration occurs late after CMC, MVR restores clinical and hemodynamic improvement in many patients.Medicine Today 2014 Vol.26(2): 111-113