902 Bileaflet mitral valve orientation — is it associated with obstructive valve thrombosis? A transesophageal echocardiographic study

Abstract

2 , 2 Institute for Cardiovascular Diseases, Belgrade, Yugoslavia Objective: Preservation of the posterior leaflet during mitral valve replacement in patients (pts) with mitral regurgitation has been proven beneficial for postoperative left ventricular performance. Some authors have been stating that posterior leaflet preservation during every mitral valve replacement was highly beneficial both post- operatively as well as long-term. The aim of our study was to investigate long-term effect of this technique in pts with rheumatic mitral stenosis. Patients and Methods: We studied 20 pts with mitral valve replacement for rheumatic mitral stenosis operated from 1989-1990. In all pts a Carbomedics valve was inserted. In group A (10 pts) the posterior leaflet was preserved, while group B (10 pts) underwent excision of both leaflets with corresponding chordas. In both groups hemodynamic characteristic of the valve and the left ventricle, based on echocardiographic findings 12 years later, were compared. We determined maxi- mal (PG) and mean (MG) transmitral valvular gradients, as well as the effective area of inserted valvular opening (AREA), telediastolic (TDV) and telesystolic (TSV) left ventricular volume, stroke volume (SV), ejection fraction (EF), fractional shortening (FS) and segmental left ventricular motion. Results: The mean size of inserted valve was 27.4 in group A and 26.6 in group B. We found no difference between the two groups according to hemodynamic data: PG (10.4 vs 11.1mmHg), MG (4.0 vs 3.5 mmHg), AREA (2.3 vs 2.37cm2), TDV (114.5 vs 133.7ccm), TSV (36.6 vs 46.2ccm), SV (53.7 vs 83.7ccm), EF (67.1 vs 63.7%), FS (38.2 vs 33.7%). Dyskinesis of the corresponding segments was found in 3 patiens in group A and in one patient in group B. Conclusion: In pts with rheumatic mitral stenosis and valve replacement, posterior leaflet preservation has not been shown beneficial for left ventricular function during long-term follow-up. Adequate preservation of the posterior mitral leaflet did not change the properties of the inserted valve in long-term follow-up.