[Widening plasty of the anterior cusp in rheumatic mitral insufficiency]

The mechanism of insufficiency in rheumatic valve disease includes 1. annulus dilatation and 2. restricted leaflet motion. Aiming at improving the treatment of restriction, augmentation of the anterior mitral leaflet (AML) was achieved with a piece of autologous pericardium.

between January 1995 and December 1999, out of 274 patients refered for rheumatic mitral disease, 143 patients underwent a repair (52%), 81% of them had pure regurgitation with no stenosis. Ring annuloplasty was performed in all cases. Two techniques used for treating the restrictive componant of the regurgitation were compared in two consecutive cohort of patients: no AML augmentation (n=62) and AML augmentation (n=81). Mean age was 42 + 3 years and all preoperative variables were comparable except for the incidence of redo patients who all underwent AML extension.

in hospital mortality was 0.7% (n=1 with AML extension) and there was one early reoperation for a pericardial patch dehiscence. After a mean follow-up of 3.2 years, there was one sudden death (no AML extension). The reoperation rate was lower with (2.5%) than without (12.9%) AML augmentation (p<0.05). Echographic study showed a lower incidence of recurrency of mitral insufficiency when AML augmentation had been performed (grade 2: 9% and grade 3: 3%) as compared to no AML augmentation (grade 2: 35% and grade 3: 14%) (p<0.05). The mitral orifice area was larger (AML augmentation: 2.2 + 0.3 cm2 vs no AML augmentation: 1.8 + 0.4 cm2).

ring annuloplasty alone failed to correct rheumatic mitral insufficiency in all cases. AML augmentation improved the quality of the repair and decreased the risk of reoperation.