Early and late outcomes after prosthetic mitral valve replacement for rheumatic mitral valve disease remain suboptimal (1). Results can be improved with mitral valve repair, but it is essential that all physiologic defects are corrected at repair.
Procedure
Complete commissurotomies were performed, calcium was debrided, and thick/shortened chordae to the anterior leaflet were resected. These valves almost uniformly exhibit scarred, retracted posterior leaflets. Glutaraldehyde-fixed autologous pericardial patches were sutured into the posterior leaflet to augment surface area (2).
Although these patches often calcify long-term, valve function remained stable because the posterior leaflet primarily functioned as a baffle for anterior leaflet coaptation. Then, a full rigid annuloplasty ring was inserted, and the mobile anterior leaflet was reattached to the papillary muscles with artificial chordae.
Pericardial patches should not be inserted into the anterior leaflet, since late calcification will limit valve function. If all physiologic defects are addressed, rheumatic mitral valve repair can achieve excellent survival, good symptom relief, and low reoperation rates (3).
References
- Rankin JS, et al. The Impact of Mitral Disease Etiology on Operative Mortality after Mitral Valve Operations. Ann Thorac Surg 2018;106:1406–1413.
- Chauvaud S, et al. Valve extension with gluteraldehyde-preserved autologous pericardium. J Thorac Cardiovasc Surg 1991;102:171-177.
- El Oumeiri B, Boodhwani M, Glineur D, et al. Extending the scope of mitral valve repair in rheumatic disease. Ann Thorac Surg 2009;87:1735-1740.
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