Posterior leaflet preservation during mitral valve replacement for rheumatic mitral stenosis

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Thoracic Surgery

Background:

• Mitral valve replacement with posterior leaflet preservation has shown benefits for postoperative left ventricular (LV) performance in mitral regurgitation.
• Some studies suggest long-term benefits for LV function.

Purpose of the Study:

• To investigate the long-term effect of posterior leaflet preservation during mitral valve replacement in patients with rheumatic mitral stenosis.
• To compare LV performance and hemodynamic characteristics between patients with and without posterior leaflet preservation.

Main Methods:

• A retrospective study of 20 patients undergoing mitral valve replacement for rheumatic mitral stenosis between January 1988 and December 1989.
• Group A (10 patients): Both leaflets and chordae excised. Group B (10 patients): Posterior leaflet preserved.
• Comparison of pre- and postoperative clinical status, hemodynamic data (gradients, valve area), and echocardiographic LV parameters (volumes, ejection fraction, fractional shortening, segmental motion).

Main Results:

• No significant difference in hemodynamic parameters like pressure gradients (PG, MG) and effective valve area (AREA) between groups.
• Left ventricular volumes (telediastolic and telesystolic) and stroke volume were comparable.
• Ejection fraction (EF) and fractional shortening (FS) showed no significant long-term advantage with posterior leaflet preservation, with similar rates of diaphragmal segmental hypokinesis.

Conclusions:

• Posterior leaflet preservation in mitral valve replacement for rheumatic mitral stenosis does not offer a significant long-term benefit for left ventricular performance.
• Preserving the posterior leaflet does not adversely affect hemodynamic valvular characteristics even after long-term follow-up.