Analysis Of Clinical Effects Of Mitral Valvuloplasty For Mitral Regurgitation

Purpose:The aim of this paper is to summarize and discuss the surgical methods and therapeutic effects of mitral valvuloplasty in patients with mitral regurgitation,as well as to evaluate the curative effect of this procedureMethod:A retrospective analysis was conducted on 271 patients who underwent mitral valve plasty at our hospital between January 2007 and December 2021.The study included 158 males(58.30%)and 113 females(41.70%),with an average age of 53.32±11.49 years old.Preoperative ultrasound cardiogram(UCG)was performed for all patients,revealing the following measurements:left atrial diameter(LAD)of 44.61±8.13 mm(ranging from 27 to 66 mm),left ventricular end-diastolic diameter(LVEDD)of 56.57±7.56 mm(ranging from 34 to 84 mm),and left ventricular ejection fraction(LVEF)of 63.32±8.15%(ranging from 40%to 80%).The patients presented with moderate mitral regurgitation accompanied by organic changes in 49 cases,and severe mitral regurgitation in 222 cases with a mitral regurgitation area measuring 12.95±5.42 cm~2(ranging from 4.4 to 29.1 cm~2).Prior to the surgery,preoperative discussions were conducted,and additional examinations,including UCG,were performed.The surgery was carried out under general anesthesia,utilizing various techniques such as edge-to-edge valvuloplasty,flap cleft repair,wedge resection and suture,junction suture,,artificial chordae tendinopathy,chordae tendinopathy,and artificial ring valvuloplasty all under normal temperature cardiopulmonary bypass(CPB).Intraoperative waterflood tests were conducted to assess valve regurgitation and anastomosis degree.After the valve formation was completed,another waterflood test was performed to verify the opening and closing of the valve.Following heart relapse,the valve’s opening and closing status and overall function were evaluated using transesophageal echocardiography(TEE).Successful surgery was defined as the absence of or mild mitral regurgitation and no other complications such as mitral stenosis.Results:A total of 271 patients underwent mitral valvuloplasty,with 244 procedures deemed successful.In 27 cases,intraoperative failure led to mitral valve replacement.Fortunately,there were no intraoperative deaths.Seven patients required mitral valve replacement due to early post-surgery failure of mitral valvuloplasty,caused by regurgitation or hemolysis.Unfortunately,one patient passed away in the hospital after surgery,resulting in a mortality rate of 0.37%.The cause of death was identified as severe low cardiac output syndrome(LCOS).The remaining 236 patients were discharged without complications.Before discharge,a UCG examination was performed,revealing the following measurements:left atrial diameter(LAD)of 36.97±7.30 mm(ranging from 25 to 65 mm),left ventricular end-diastolic diameter(LVEDD)of 48.31±7.37 mm(ranging from 25 to 78 mm),left ventricular ejection fraction(LVEF)of 59.04±8.21%(ranging from 32%to 76%),and a mitral regurgitation area of 1.12±2.14 cm~2(ranging from 0 to 15.2 cm~2).The degree of mitral regurgitation showed significant improvement:214 patients had no regurgitation or mild regurgitation,20 had moderate regurgitation,and 2 had severe regurgitation.All indexes exhibited significant differences after surgery compared to preoperative measurements(P<0.05).A total of 202 patients were followed up,resulting in a follow-up rate of 85.59%.The follow-up period ranged from 3 months to 120 months,with an average follow-up time of 21.40±27.54 months.During the postoperative follow-up,several outcomes were observed:one patient died three months after surgery due to repeated heart failure complicated by infection,one patient required mitral valve replacement again two months after surgery due to valve ring avulsion resulting in LCOS death,one patient died from natural causes,and one patient successfully recovered after undergoing reverse epidemic mitral valve replacement.Nine patients exhibited moderate mitral regurgitation,and four patients had severe mitral regurgitation.However,the remaining patients did not experience any severe complications.Cardiac function significantly improved compared to patients who did not undergo surgical intervention.Additionally,color Doppler ultrasound revealed significant improvements in left atrial and left ventricular size,as well as the regurgitation status.Conclusion:Mitral valve repair surgery demonstrates favorable treatment outcomes and minimal complications in the management of mitral valve regurgitation.It can be considered as the preferred surgical approach for treating mitral valve regurgitation.By tailoring the specific repair technique to the type of mitral valve pathology,optimal results can be achieved.