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How to Do Mitral Valve Repair for Various Etiologies of Mitral Regurgitation?
김용한, 최재웅, 오홍철, 김경환
서울대학교 의과대학 서울대학교병원 흉부외과학교실
Background : Mitral valve repair is the preferred treatment for patients with any cause of mitral valve regurgitation (MR). The aim of this study was to introduce details of our techniques and evaluate the outcomes of mitral valve repair according to the etiology of MR.
Methods : Between January 2004 and May 2014, 159 patients aged 53.4±13.6 years (range 19 to 77) underwent mitral valve repair for MR. The patients were further classified according to the etiology of mitral valve disease, being degenerative(fibroelastic deficiency or Barlow disease), rheumatic, ischemic, endocarditis, or congenital. The majority of the etiology was fibroelastic deficiency in 117 patients (73.6%), and second most common was endocarditis in 14 patients (8.8%). Postoperative echocardiography was performed in all patients, and we reviewed the medical records of the patients retrospectively to compare the clinical outcomes.
Results : There was no early (within 30 days postoperatively) mortality. Three patients (1.9%) had more than mild MR at discharge, and 5 (3.1%) had more than mild MR after 1 year of follow-up. Most patients (124/159, 78.0%) underwent mitral valvuloplasty (MVP) along with mitral annuloplasty (MAP), and 18 (11.3%) underwent MAP alone. The method of mitral valve repair was segmental leaflet plication, triangular or quadriangular resection, artificial neochordae implantation, chordal transfer, resection of secondary chordae resection according to the morphology of the regurgitation. MVP alone was performed in 8 patients (5.0%) with congenital MR, and in 5 (3.1%) using the Alfieri technique. For adequate exposure of valve repair, we all performed annuloplasty suture first starting from P2 area. Three patients required reoperation because of postoperative bleeding, 3 required mitral valve replacement due to recurrence of MR, and 1 needed heart transplantation due to low cardiac output syndrome. We are going to present valve repair video for various etiologies of MR.
Conclusion : Mitral valve repair can be performed in all types of mitral valve regurgitation with reasonable results regardless of etiology.
Methods : Between January 2004 and May 2014, 159 patients aged 53.4±13.6 years (range 19 to 77) underwent mitral valve repair for MR. The patients were further classified according to the etiology of mitral valve disease, being degenerative(fibroelastic deficiency or Barlow disease), rheumatic, ischemic, endocarditis, or congenital. The majority of the etiology was fibroelastic deficiency in 117 patients (73.6%), and second most common was endocarditis in 14 patients (8.8%). Postoperative echocardiography was performed in all patients, and we reviewed the medical records of the patients retrospectively to compare the clinical outcomes.
Results : There was no early (within 30 days postoperatively) mortality. Three patients (1.9%) had more than mild MR at discharge, and 5 (3.1%) had more than mild MR after 1 year of follow-up. Most patients (124/159, 78.0%) underwent mitral valvuloplasty (MVP) along with mitral annuloplasty (MAP), and 18 (11.3%) underwent MAP alone. The method of mitral valve repair was segmental leaflet plication, triangular or quadriangular resection, artificial neochordae implantation, chordal transfer, resection of secondary chordae resection according to the morphology of the regurgitation. MVP alone was performed in 8 patients (5.0%) with congenital MR, and in 5 (3.1%) using the Alfieri technique. For adequate exposure of valve repair, we all performed annuloplasty suture first starting from P2 area. Three patients required reoperation because of postoperative bleeding, 3 required mitral valve replacement due to recurrence of MR, and 1 needed heart transplantation due to low cardiac output syndrome. We are going to present valve repair video for various etiologies of MR.
Conclusion : Mitral valve repair can be performed in all types of mitral valve regurgitation with reasonable results regardless of etiology.
책임저자: 김경환
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 김경환, Tel: 02-2072-3971 , E-mail : kkh726@snu.ac.kr
