| Surgical Procedures and Long-Term
Results of Intraoperative Re-do Mitral Valve Repair |
(Department of Cardiovascular Surgery, Sakakibara
Heart Institute, Tokyo, Japan)
| Tomoki Shimokawa |
Hitoshi Kasegawa |
Katsuhiko Kasahara |
| Yasushi Matsushita |
Satoshi Kamata |
Takao Ida |
| Mitsuhiko Kawase |
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We examined the surgical procedure
and long-term results in patients who underwent intraoperative
re-do for the completion of mitral valve repair. Between March
1993 and July 1996,81 patients underwent mitral valve repair
for pure MR using TEE evaluation. Of these, 12 patients that
were judged to have more than mild residual regurgitation（MRA≧2.0cm2
or MRL≧1.0cm）underwent intraoperative re-do. All of the patients
were type 2，according to Carpentier's classification. Seven patients
had degenerative disease and 2 had infective endocarditis. If
the cause of residual MR was localized discoaptation，5-0 suture
plication with beating heart that increased the coaptation zone
and resulted in decrease in the residual MR was useful. If the
cause of residual MR was leaflet prolapse or dehiscence, intraoperative
re-do was performed the cardiac re-arrest. Two patients of billowing
valve underwent MVR and the other needed additional resection
of leaflet, artificial chorda or suture. After intraoperative
re-do, every procedure resulted in a reduction of MR except for
2 patients underwent MVR during the early postoperative stage,
and of those all but one remaine no-to-mild MR in the late term（mean
follow-up 26.2 months). In conclusion，5-0 suture plication was
effective for intraoperative re-do procedures, and basic mitral
valve repair modification was necessary in about half of the
cases. Intraoperative re-do was safely performed with no mortality
or morbidity and it yielded good long term results. Intraoperative
TEE evaluation was considered to be important.
Jpn. J. Cardiovasc. Surg. 29: 239-244 (2000) |
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