POSTOPERATIVE ASSESSMENT OF CHORDAL PRESERVATION AND CHANGES IN CARDIAC - GEOMETRY FOLLOWING MITRAL-VALVE REPLACEMENT

Mitral valve replacement (MVR) is still associated with a relatively h igh mortality, To investigate the influence of chordal preservation in MVR on left ventricular size and function, rue studied a series of 82 patients who underwent MVR either with (group A n = 50) or without (g roup B n = 32) preservation of the subvalvular structures and compared the two groups. Echocardiography was performed preoperatively, and 7 days and 3 months postoperatively. Echocardiographic investigations in cluded left atrial and ventricular diameters, right ventricular diamet ers and left ventricular length. Preoperatively there were no differen ce between the two groups of patients. Intraoperative and postoperativ e management was similar in the groups. Three months postoperatively e chocardiographic examinations demonstrated that chordal preservation i n MVR resulted in smaller left ventricular systolic and diastolic diam eters (LVESD: gr. A 43.4+/-7.8 mm vs gr. B 48.8+/-9.2 mm P<0.05, LVEDD : 57.3+/-7.8 tnm vs 62.9+/-10.5 mm P<0.05) and a significantly decreas ed left ventricular length (87.1+/-4.2 mm in gr. A vs 97.5+/-5.7 mm in gr. B P<0.05). In addition, left ventricular ejection fraction in gro up A was significantly improved compared to group B (54.2+/-11.2% vs 4 8.1+/-12.4%. P<0.05). We conclude that chordal preservation in MVR imp roves left ventricular function and reduces left ventricular diameters and volumes compared to resection of the mitral subvalvular appartus and that these beneficial effects can be maintained in the postoperati ve course.