Plástica da valva mitral: resultados aos 17 anos de experiência

Pomerantzeff, Pablo Maria Alberto; Brandão, Carlos Manuel de Almeida; Faber, Cristiano N.; Fonseca, Marcelo Heleno; Puig, Luiz Bóro; Grinberg, Max; Cardoso, Luís; Tarasoutchi, Flávio; Stolf, Noedir A. G; G, Verginelli; Jatene, Adib

doi:10.1590/s0102-76381999000300002

Cited by 14 publications

(12 citation statements)

References 20 publications

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“…Pomerantzeff et al 21 reported reoperationfree survival in 70% after 17 years 21 . Patients with rheumatic valve disease have had a high incidence of reoperation, as demonstrated by Deloche et al 9 .…”

Section: Discussionmentioning

confidence: 99%

Plastia mitral cirúrgica em crianças com febre reumática

Silva¹,

Herdy²,

Vieira³

et al. 2009

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Plastia mitral cirúrgica em crianças com febre reumática

Silva¹,

Herdy²,

Vieira³

et al. 2009

Arq. Bras. Cardiol.

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“…However, in our country, rheumatic etiology is prevalent and, in this population, the long-term outcomes may be affected by the appearance of new outbreaks of the disease [7]. Despite this fact, every effort must be made in order to perform conservative treatment, since a large proportion of these patients are young and therefore subject to greater number of surgical interventions during evolution [8,9]. Other factors to be considered are the difficulty of anticoagulation of patients in our country and early calcification of bioprostheses in this age group.…”

Section: Discussionmentioning

confidence: 99%

Plástica da valva mitral em pacientes com insuficiência mitral reumática: técnicas e resultados de 20 anos

Pomerantzeff¹,

Brandão²,

Filho³

et al. 2009

Rev Bras Cir Cardiovasc

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Objective: Mitral valve repair in rheumatic patients is still a challenge. The aim of this study is to assess the results of mitral valve repair in rheumatic patients with rheumatic mitral insufficiency.Methods: 330 patients with rheumatic mitral insufficiency who had undergone mitral valve repair in the Heart Institute HC-FMUSP were assessed retrospectively, between 1985 and 2005. The mean age was 26.9 ± 15.4 years and 57.6% were female. On preoperative assessment, 39.5% of patients were in NYHA functional class IV. The most common techniques for repair employed were bovine pericardial strip annuloplasty in 48.4% patients and Carpentier ring annuloplasty in 22.6%. Shortening of chordae (20%) and papillary muscle splitting (17.8%) were the most common associated techniques performed. Tricuspid valve repair (26.7%) and aortic valve replacement (27.2%) were the most common associated procedures.Results: The hospital mortality was 0.9% (three patients), two of them children with active rheumatic fever. Linearized rates of thromboembolism, endocarditis, reoperation and late death were 0.2%, 0.2%, 3.5% and 0.5% patients-year, respectively. Actuarial survival in 20 years was 86.4 ± 6.6%.

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“…Quadrangular resection associated with or not "sliding" repairs is the normal technique for this indication. Annuloplasty with a prosthetic ring to reestablish the format of the mitral valve orifice, in all chronic diseases of the aforementioned cases, is accepted by the majority of surgeons [11]. The tendency is to implant the largest ring possible, as implantation of the ring is not used to restrict the mitral valve surface, but to reshape the orifice [11].…”

Section: Commentsmentioning

confidence: 99%

“…These two techniques, used by many surgeons, present questionable limitations and results [8,9]. In our experience, we repair anterior leaflet prolapse with a reproducible and safe technique: papillary muscle repositioning (PMR) [10,11]. The aim of this study was to describe the technique and the results and to recommend this technique as the standard procedure.…”

Section: Introductionmentioning

confidence: 99%

<![CDATA[Papillary muscle repositioning: the gold standard technique to repair anterior mitral leaflet prolapse]]>

Neto¹,

Aubert²,

Pawale³

et al. 2005

Braz. j. cardiovasc. surg.

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RBCCV 44205-773Reposicionamento do músculo papilar: a técnica padrão para plastia do prolapso da cúspide anterior da mitral Papillary muscle repositioning: the gold standard technique to repair anterior mitral leaflet prolapse Abstract Objective: The aim of this study was to demonstrate that papillary muscle repositioning is a reliable technique to repair anterior leaflet prolapse. Therefore we describe this technique and its long term results to propose it as a gold standard.Methods: Between 1989 and 2005, 120 mitral valve repairs were consecutively performed using papillary muscle repositioning in cases of anterior leaflet prolapse. There were 87 males and 33 females, the mean age was 59 ± 11.5 years. 59% of patients were in NYHA III or IV. Mean ejection fraction was 65.7 ± 8.9%. Predominant aetiology of mitral regurgitation (MR) was degenerative: Barlow (n=43) and dystrophic (n=62). The other aetiologies were: healed endocarditis (n=5), rheumatic (n=5), ischemic (n=4), congenital (n=1). A posterior papillary muscle repositioning was performed in 111 (92.5%) cases and an anterior in 38 (31.7%). Associated procedures were carried out in 76 (63.3%) patients.Results: There were no in-hospital deaths. During the follow-up, 14 patients (11.7%) died, including 7 (5.8%) due to cardiac causes. The cumulated survival rates at 1, 5, 10 and 15 years were 98.3%, 97.2%, 94.1% and 81.4% respectively. Two patients (1.7%) were reoperated for recurrency of the regurgitation, they underwent a replacement of the valve 1 and 5 years after the repair and died 3 and 6 years, respectively after this replacement. There was no systolic anterior motion. The cumulated survival rates free from reoperation involving the mitral valve at 1, 5, 10 and 15 years were 97.4%, 97.4%, 92.8 % and 86.7% respectively. We did not find any risk factor of mortality or of reoperation. The follow-up was completed for all the patients. After a median follow-up time of 5.9 years (range from 0.1 to 15.6 years) 87 patients were in NYHA class I (72.5%), the echocardiographic control showed no or minimal insufficiency in 89 patients (74.2%), mild insufficiency in 8 patients (6.7%) and moderate insufficiency in 9 patients (7.5%).Conclusions: Papillary muscle repositioning is a reliable and safe technique, with excellent clinical and echocardiographic long term results. Therefore we propose it as a gold standard to repair anterior leaflet prolapse. 0,1 a 15,6 anos), 87 (72,5%) pacientes estavam na classe I -NYHA, o controle ecocardiográfico mostrou nenhuma ou mínima regurgitação em 89 (74,2 %) pacientes, leve regurgitação em oito (6,7%) e moderada regurgitação em nove (7,5%). DescriptorsConclusão: O reposicionamento do músculo papilar é uma técnica confiável e segura, com excelentes resultados clínicos e ecocardiográficos a longo prazo. Desta maneira, estamos propondo-a como padrão para o reparo da cúspide anterior prolapsada.Descritores: Prolapso das valvas cardíacas. Insuficiência da valva mitral, cirurgia. Valva mitral, cirurgia.

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Plástica da valva mitral: resultados aos 17 anos de experiência

Cited by 14 publications

References 20 publications

Plastia mitral cirúrgica em crianças com febre reumática

Plastia mitral cirúrgica em crianças com febre reumática

Plástica da valva mitral em pacientes com insuficiência mitral reumática: técnicas e resultados de 20 anos

<![CDATA[Papillary muscle repositioning: the gold standard technique to repair anterior mitral leaflet prolapse]]>

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