[Mitral valve remodeling using valvuloplasty, chordoplasty and ring annuloplasty]

Degenerative mitral valve disease is a major cause of mitral regurgitation and mitral valve repair has acquired greater importance as a surgical treatment of mitral regurgitation. Since 1991 we have used mitral valve repair to remodel the mitral valve leaflet, chordae tendineae and annulus. The final aim of our mitral valve remodeling technique is to correct the coaptation line of both leaflets. Forty-eight patients who underwent mitral valve repair were analyzed to evaluate the effect of the mitral valve reconstructive technique. We compared the left ventricular function and mitral valvular function by echocardiography and also the left ventricular pressure volume area, which reflects the oxygen consumption of the myocardium, before and after operation. The actuarial survival from all deaths, including one hospital death and one noncardiac death, was 95.8% at 60 months. Three patients have required reoperation because of recurrent regurgitation. Freedom from reoperation at 5 years was 93.8%. Left ventricular end-diastolic (122.3 +/- 45.8-->66.4 +/- 33.8 ml/ m2) and end-systolic volume indexes (39.6 +/- 19.5-->30.1 +/- 18.9 ml/m2) significantly decreased after mitral valve repair, and left ventricular volume overload was markedly reduced. Left ventricular ejection fraction and fractional shortening, which were apparently good before operation, were within the normal range after operation. Left ventricular inflow velocity and mitral pressure gradient were unchanged before and after repair. Mitral valve orifice area was 3.20 +/- 1.08 cm2 and did not show signs of mitral stenosis after repair. The reduction of left ventricular pressure volume area after repair was 53.6 +/- 12.4%, showing marked reduction of the oxygen consumption of the myocardium after successful mitral repair. Left ventricular and mitral valvular function is well preserved after mitral valve remodeling. Mitral valvular function after mitral repair exceeds that of the mitral valve replacement. Mitral valve remodeling procedures are very useful for patients with mitral regurgitation due to mitral valve prolapse.