Clinical Analysis Of Mitral Valvuloplasty In45Patients For Mitral Insufficiency

Objective:To investigate the clinical effect of mitral valvuloplasty for mitral valve regurgitation and studied the relationship between Preoperative EF and LV end-systolic diameter and occurrence of LV dysfunction after mitral valvuloplasty.Methods:From June2007to March2010in the second affiliated hospital of Zhengzhou university,a total of45consecutive patients with mitral valve insufficiency whom undertaken mitral valvuloplasty were summarized retrospectively, including20males and25female patients, ages2-66years, mean(39.418.9) years old. Etiology:there were32cases of mitral degenerative prolapse,2of ischemic mitral valve insufficiency,8of congenital mitral valve disease,1of rheumatic mitral valve disease, and2of infective endocarditis. Preoperative New York Heart Association (NYHA) classification indicated that there were4patients in class1,29in class Ⅱ and12in class Ⅲ. Preoperative echocardiographic measurements of the diameter of the left atrium (LA) was47.13±10.86(22to56) mm, left ventricular end-diastolic diameter (LVEDD) was54.84±9.31(36to63) mm, left ventricular ejection fraction (LVEF) was62.16±6.10(42to77)%, left ventricular end-systolic diameter (LVESD) was40.40±6.43(29to58) mm, degree of mitral regurgitation (reflux area and left atrial area ratio) was38.44±8.23%. All patients had been operated underwent cardiopulmonary bypass with mild hypothermia. The Valvuloplasty technique included sliding technique, quadrangular resection, annuloplasty, chordal transfer technique, edge to edge technique. During the operation, the method to evaluate the surgical efficacy was by saline injection test. After one week, echocardiogram indicated the change between preoperative and postoperative. The follow-up examination was by telephone or outpatient.Results:Echocardiography evaluation showed that after the operation that the left atrial dimension, left ventricular end-diastolic diameter, left ventricular endsystolic diameter, the ejection fraction, the degree of mitral regurgitation (reflux area and left atrial area ratio) were significantly decreased. Postoperative follow-up ranged from3months to4years, and there was only one patient death early postoperative because of heart failure. The cardiac function ranged from NYHA Class Ⅰ to Ⅲ. There were13people suffer the post-operative LV dysfunction (EF<50%).On the basis of a analysis, the number of post-operative LV dysfunction was1when EF was≥64%and LVESD<37mm,2with EF<64%or LVESD≥37mm, and10with EF<64%and LVESD≥37mm.Conclusions:1. According to the different causes of mitral regurgitation lesions and pathological features, we can corrective regurgitation effectively and improve cardiac function With proper valvoplasty technique.2. Preoperative EF and LV end-systolic diameter allow the prediction of LV dysfunction after MVP in patients.