A Retrospective Study Of The Clinical Efficacy Of Various Mitral Valve Repair Techniques In52Cases

Background:MV plays an important role in left ventricular performance in different aspects. Duringthe early diastole, major portion of blood flow through MV. Primarily depends on the activerelaxation of left ventricular myocardium and passive forces along with the mitral annulusmovement. During the ventricle contraction, CT prevents the valve from being pushed back.The CT are tethered and forms an extensions of left ventricular muscle wall as PapillaryMuscles which are mound like, these probably provides stability but cannot activelyparticipate in opening and closing of the Valve. CT are inserts into the undersurfaces ofmitral leaflets, thus contributes to the mitral valve competency and preventing the leafletprolapse into left atrium during systole. The main cause of mitral regurgitation (MR) isdegenerative mitral valve disease leads to mitral valve prolapse or posterior and anterior flailor in both leaflets[45]. In MS, mitral valve orifice damages impairs ventricular filling thusreduces the cardiac output by which less blood will supply to the body and the atrium swellsas the pressure will builds up. Stenotic MV creates a diastolic gradient between left atriumand left ventricle, commonly associated with left atrial pulmonary arterial pressure andcapillary wedge pressure which is commonly observed in tachycardia. Left atrium pressureincreases before the buildup of pressure in aortic root, around of the ejected LV volume.As the LA pressures abruptly increases, which is controlled poorly leads to the onset ofpulmonary edema in Acute MR, whereas in chronic MR, the pressure is controlled withmoderate increase in LA pressure which allows the elevation of stroke volume to maintainthe MR volume. During contraction one of the flaps will flop back into the left atrium. Mostcommon segment involved is P2segment. If any disruption in the morphology or anychanges geometrically or mechanically the balance between the MV components, whichincludes leaflets, chordae tendineae, annulus, papillary muscles leads to mitral regurgitationwhich is mostly observing now a days along with other heart disorders. In this study, weobserved the efficacy of MV repair in52patients with successful outcome of100%. Mostly,males are affected than females. Previously reported that, heart valves have distinctautonomic interventional patterns in which if there is a dysfunction of nerve terminals theleaflets could be correlate with mitral valve prolapse. The major concern is to determine the length of chordae properly, so that for furtherexamining it will be useful for categorization functionally and anatomically. Standardizedimage assessment and interpretation is required to understand the MV apparatus functionwhich is the crucial and essential to overcome the alterations of the annulus and helpful inrepair techniques. Some revealed that artificial chordae with multiple interdependent looptechnique will be useful to repair the Barlow’s disease. Mostly, prolapse of posterior leafletcan be treated with leaflet resection with good results. Whereas, the surgical correction ofanterior or both the leaflet prolapse or large areas of posterior leaflet is more complicated andcomplex. There are techniques which are introduced by Carpentier, includes quadrangularresection, transfer of native chordae and papillary muscle shortening or plasty can be moredemanding technically in the treatment of complex lesions.Objective:To study the morphological characteristics of mitral valve apparatus and also the preferablevalve repair technique.Materials&Methods:In this retrospective study, we selected the52patients with mitral valve repair, wereselected from the Department of Cardio-Vascular Surgery in China-Japan Union Hospital ofJilin University. Out of which, male67%(n=35), female33%(n=17) with the mean age of46.3±13.8years. The observed signs and symptoms which are occurred≥3months.Patients who are having previous cardiac surgery or any other surgeries, with palpitations andmurmur from a period of time, without severe heart failure, who are having right sided heartdiseases are included in this study. Patients who are having Respiratory failure, documentedallergies, transmitted diseases, and also any History of asthma were not included in this study.Depend upon the severity of regurgitation and annular dilation, mitral valve repair is done inall52patients and functional mitral Regurgitation is present in all patients with concomitantaortic/tricuspid valve diseases and other right sided heart diseases. Intraoperativeregurgitation area is to be finded by executing the saline injection test. By reviewing throughcolor Doppler Echocardiography, we noticed mitral regurgitation in39patients, whereas in13patients mitral regurgitation observed intra operatively, and there by demonstrating the cardiac apex in four chamber view, and graded as mild, moderate. There are no severeregurgitation and massive regurgitation patients. Along with regurgitation there are otherdiseases also present in these52patients.Results:All the52patients have successful recovery post operation and there are nocomplications during surgery and hospital stay. Only for2patients, have complaints withAnnuloplasty (Ring)1patient, Annuloplasty (No Ring)1patient with age ranging53-62years old. In1male patient with age53discomfort appeared3months after surgery and in1female discomfort appeared4months prior to surgery. According to Chi-Square (χ2)statistics, for two degrees of freedom is2.249. It indicates that the significance value(P=0.134) is greater than the standard value of0.05, suggests that methods are not significant.This explains that we can use any preferred technique to resolve the problem.Conclusion:According to our outcome, we conclude that Mitral valve repairs with Ring are mostlikely to be done to improve the myocardial activity and to increase the patient’s life span, inwhich males are most likely to be effected than females. Morphology of the annulus has beenconsidered to repair. The geometrical and morphology of mitral annulus is very importantwhile doing the procedure. Annuloplasty Ring is recommended to secure the annular ring andto obtain reasonable postoperative clinical outcomes.