Effects of subvalvular apparatus preservation in mitral valve replacement among rheumatic patients: early and mid term follow up.
DOI:
https://doi.org/10.59779/jiomnepal.881Keywords:
mitral valve replacement, subvalvular apparatus preservation, left ventricular diastolic dimension,, left ventricular systolic dimension, ejection fractionAbstract
Introduction: Annulo-papillary continuity exerts significant impact on postoperative left ventricular function after mitral valve replacement.
Methods: This is a retrospective study of patients who had undergone mitral valve replacement at one of the three units of Shahid Gangalal National Heart Center. Patients were divided into three groups, group I: total resection of subvalvular apparatus, group II: posterior mitral leaflet preservation, group III: total preservation of subvalvular apparatus. Statistical analysis was done to see the differences between three groups in regards to left ventricular dimensions in diastole, systole and ejection fraction.
Results: Total of 93 patients underwent mitral valve replacement from April 14, 2011 to April 13,2012. Among group I patients, left ventricular diastolic (LVIDd) dimension decreased significantly at 3 months follow-up: group II patients left ventricular systolic dimension (LVIDs) decreased significantly at 3 months, group III patients, both LVIDd and LVIDs decreased significantly at 3 months. At the end of 3 years, the graph showed patient with group I had increasing tendency for LVIDd, whereas patients with group III had decreasing tendency for LVIDd. Similarly patients in group I showed increasing trend for LVIDs, whereas it got stabilized after 2nd year among patients in group III. The ejection fraction was most improved among the patients with group III compared to group I or II.
Conclusion: Total subvalvular apparatus preservation during mitral valve replacement did have positive impact on left ventricular dimensions as well as function in early and midterm follow-up
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