Key result
Mitral valve replacement with preservation of the posterior mitral apparatus in patients with mitral stenosis resulted in poorer left ventricular functional response to exercise compared to conventional replacement.
Why the study?
Does MVR with preservation of the posterior mitral apparatus improve postoperative cardiac function compared to conventional MVR in patients with mitral stenosis?
Cohort (n=36)
No
Does MVR with preservation of the posterior mitral apparatus improve postoperative cardiac function compared to conventional MVR in patients with mitral stenosis?
Preservation of the hypertrophic and sclerotic subvalvular tissue during MVR for mitral stenosis may disturb left ventricular diastolic wall motion compared to conventional MVR.
Answers are grounded in this paper and cite their sources.
May caution against posterior apparatus preservation in mitral stenosis MVR; leaves open optimal technique pending prospective trials.
Postoperative cardiac function was evaluated by dynamic exercise echocardiography in 36 cases with mitral stenosis, and electron microscopic examination of the LV myocardial cells was also carried out. Ultrastructual changes of the LV myocardial cells were graded into scores (EM-score).EM-scores correlated with %FS (r=-0.54), mVcf (r=-0.60) at rest and %FS (r=-0.54), mVcf (r=0.50) after exercise.In 36 cases, 25 cases underwent conventional MVR (group I) and 11 underwent MVR with preservation of the posterior mitral apparatus (group II). When postoperative cardiac function was compared in 13 cases less than 4 of EM-score in group I because EM-scores were less than 4 in all cases in group II, no difference was observed in two groups except for mVcf at rest. The values of %ΔFS and %ΔmVcf in group I Were better than those in group II.This suggests that preservation of the hypertrophic and sclerotic subvalvular tissue in mitral stenosis disturbs the LV diastolic wall motion.
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Takeshi Shichijo (1992) conducted a cohort in Mitral stenosis (n=36). Mitral valve replacement with preservation of the posterior mitral apparatus vs. Conventional mitral valve replacement was evaluated on Postoperative cardiac function response to exercise (%ΔFS and %ΔmVcf). Mitral valve replacement with preservation of the posterior mitral apparatus in patients with mitral stenosis resulted in poorer left ventricular functional response to exercise compared to conventional replacement.
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