Experiência com dois tipos de técnicas para o tratamento cirúrgico da insuficiência mitral: I. Prótese com preservação de elementos do sistema valvar. II. Plastia valvar com reconstrução e avanço da cúspide posterior

Cirurgia da insuficiência mitral no tratamento da insuficiência cardíaca avançada

“…Therefore, in 1982, one of the authors (PRBE) and associates, even without taking into account the possibility of valve replacement in the context of DC, tested five techniques to preserve the mitral subvalvular apparatus in 23 patients with rheumatic mitral valve disease -in some, calcified -who had undergone valve replacement: a) attachment of the top of the papillary muscles in the posterior ring in thirteen patients (Figure 1), b) attachment of the papillary muscles and tendinae chordae to the posterior annulus in four patients (Figure 2), c) partial excision of the anterior leaflet with attachment of its set of cords and preservation of the tendinae chordae of posterior leaflet in four patients ( Figure 3), and 4) preservation of the entire mitral subvalvular apparatus in two patients (Figure 4). One should add to these four variants that from David et al of partial excision of the anterior leaflet and plication of the posterior one ( Figure 5) [62].…”

Reconstructive surgery for aortic valve disease

“…On the basis of previous experience with posterior leaflet advancement with homologous dura mater or glutaraldehyde tanned bovine pericardium 29 for surgical treatment of mitral insufficiency, a similar technique was devised by us for correction of aortic valve regurgitation. The initial idea involved enlarging one or more of the cusps, in association or not with commissural resuspension.…”

“…Clinical application of glutaraldehyde treated bovine pericardium came next and due to its great availability this material came to be extensively used for valve replacement and repair, particularly of the mitral valve [26][27][28][29] . Application of this biologic tissue for surgical repair of the aortic valve damaged either by rheumatic fever or by congenital or degenerative disease has been very exciting [30][31][32] .…”