[Aortic failure neglected in surgery of mitral or mitro-tricuspid valve diseases]

The objective of this study was to determine the outcome of neglected minimal or moderate aortic regurgitation during mitral or mitro-tricuspid valve surgery. 42 patients were included in this survey between 1985 and 2002. There were 17 men and 25 women aged 9-54 years (mean age: 22 +/- 10 years). Etiology was dominated by acute rheumatic fever (91%). Associated lesions were observed: mitral valve incompetence 11 cases, mitral valve stenosis 9 cases, mitral valve incompetence plus mitral valve stenosis in 8 pateints and mitro-tricuspid valve disease in 14 others. All the patients were symptomatic (NYHA class II 79%, NYHA class III or IV 20%). 90% of patients had a radiological cardiomegaly: mean cardio-thoracic was 0.62. At electrocardiogram, 79% of patients were in sinus rhythm and 57% presented a left ventricular hypertrophy. Minimal or moderate aortic regurgitation has been confirmed by echocardiography and angiocardiography in all patients. Surgical treatment was a mitral valve replacement (n = 35.83%), a mitral valvuloplasty (n = 5.12%), a mitral valve replacement and a tricuspid valve annuloplasty according to DE VEGA technique (n = 2.5%). The operative mortality was 4.7% (2 deaths) due to an acute cardiac failure (1 case) and prosthetic valve endocarditis (1 case). 19 patients have been followed up from a mean 1 month to13 years (mean follow-up: 5 years). The follow-up has been marked by a regression or a stability of the neglected aortic incompetence , a regression of the mean cardio-thoracic ratio from 0.62 preoperatively to 0.56 postoperatively, an improvement of the functional status (84% of cases). We conclude that the neglected aortic incompetence during mitral or mitro-tricuspid valve surgery do not tend to aggravate during follow-up.