MITRAL VALVE REPAIR

EXPERIENCE IN HARAPAN KITA HOSPITAL

Maizul Anwar ,MD

NATIONAL CARDIOVASCULAR CENTER HARAPAN KITA
INDONESIA
2008

Background
Mitral Valve Repair is applicable in the majority of the
patients and has become the procedure of choice.
We have been using several techniques in order to
widen the spectrum of patients eligible for MV Repair.
This variation leads to several variation on result of
the operation and the patient characteristic.

Mitral Valve Repair v.s

Mitral Valve Replacement
Advantages
Preservation of LV function
Low rates of thromboembolism
Lack of a requirement for
anticoagulants
Excellent duration

Patient & methods

A retrospective review of 49 patients who underwent
isolated MV repair from January 2005 to December 2007
in Harapan Kita Hospital Jakarta.
The operation was performed through a median
sternotomy employing moderate systemic hypotermia
and antegrade/retrograde cold blood cardioplegia.
A transesophageal echocardiography examination was
carried out intraoperatively immediately before and after
repair.
Transthoracic echocardiography was performed before
discharge.

Results
Mean Age was 45,2715,40 years. Male 53,1% and female 46,9%.
Preoperative NYHA was class II in 61,2%, class III in 28,6% and class IV
in 10,2%. Etiology of MV disease was degenerative 83,7%, rheumatic
14,3% and endocarditis 2%.Left ventricular end-diastolic dimension(EDD)
was 54,9410,04 mm. Left ventricular end-systolic dimension(ESD) was
37,299,13 mm. The size of LA was 44,6510,92 mm. Mean EF was
62,5511,04. Sinus rhythm was 73,5% and atrial fibrillation was 24,5%.
Several procedure MV Repair was performed in these patients. Mean ICU
stay was 2,314,10 day. MR grading after repair was none in 26,5%,
trivial in 42,9%, mild in 26,5% and moderate in 4,1%. In-hospital mortality
was 4,1%.

Valvular Lesion

No. (%)

Annular dilatation

1 (2 %)

Elongatio chordae

11 (22,4 %)

Rupture chordae

24 (49%)

Commisural fusion

1 (2%)

Annular dilatation,elongatio,rupture

2 (4,1%)

Elongatio,rupture chordae

6 (12,2%)

Annular dilatation,commisural fusion

3 (6,1%)

Chordae retracted

1 (2%)

Mitral valve Prolapse

Annulus dilatation
Leaflet
perforation

Type I

Type II

Ruptured
chordae
Elongated
chordae
Rupture
papillary
muscles
Elongated
papillary
muscles

Type IIIa

Commissure
fusion
Leaflet thickening
Chordae fusion

Ventricular
dilatation
Ventricular
dyskinesia

Type IIIb
A Carpentier : J Thorac Cardiovasc Surg 1983;86:323-37

MV Repair procedure

No. (%)

Leaflet resection+Ring

16 (32,7%)

Chordal procedure+Ring

11 (22,4%)

Commisurotomy+Ring

1 (2%)

Commisurotomy+Chordal+Ring

2 (4,1%)

Artificial chordae

1 (2%)

Leaflet resection+Ring+commisuroplasty

1 (2%)

Only Ring

6 (122%)

Chordal procedure

2 (4,1%)

Leaflet resection

1 (2%)

Leaflet resection+Chordal+Ring

8 (16,3%)

Leaflet Resectiion

Chordal Transfer

Ring Annuloplasty

Artificial Chordae

Type of
complication/morbidity

No. (%)

Stroke+MRSA infection

1 (2%)

Re-exploration ec
bleeding/tamponade+CVVH

3 (6,1%)

IABP+CVVH+stroke+MRSA

1 (2%)

Conclusion
Most of the patients at middle age, NYHA class II, sinus
rhythm and normal EF. The size of the heart within slightly
normal limit
Most of the patients were degenerative, with chordal rupture,
and PML prolapse.
Every patient underwent several operation procedures :
leaflet resection, chordal procedure, and artificial chordae
with ring annuloplasty for most of the patients.
The most common morbidity were re-exploration
bleeding/tamponade and acut renal failure.
In-hospital mortality was
syndrome.

4%. Cause of death was

ec

septic

THANK YOU