MITRAL VALVULOPLASTY WITH A NEW PROSTHETIC RING - ANALYSIS OF THE 1ST105 CASES

From October 1987 to March 1993, 105 patients were studied who have un dergone valvuloplasty with an open ring. They ranged from 5 to 79 year s (mean 30); 33 (31.4%) were under 16. All patients had mitral insuffi ciency, alone in 62 (59.0%) and associated with mitral stenosis (doubl e mitral lesion) in 43 (41.0%). In the majority of the cases, the aeti ology was rheumatic (78.1%); active in 10 (9.5%) patients. Three patie nts (2.9%) were in class II, 42 (40.0%) in class III, 57 (54.3%) in cl ass IV and 3 (2.9%) in class V. Ten patients (9.5%) had isolated ring implantation while the remaining underwent associated procedures on th e leaflets, chordae and papillary muscles. There were two (1.9%) hospi tal deaths, and six patients (5.7%) had to be reoperated. On the 30th (mean) postoperative day, 75 (71.4%) patients were reevaluated by cath eterization, echo Doppler or both to confirm the effectiveness of the techniques employed. The mitral valve was functioning normally or with mitral regurgitation + in 63 (84.0%) patients, mitral regurgitation + in 2 (2.7%), mitral regurgitation + + + in 5 (6.7%), mitral stenosi s + in 4 (5.3%), and mitral stenosis + + in 1 (1.3%) patient. The resu lts were therefore considered excellent in 63 (84.0%) patients with ei ther normal mitral valve or mitral regurgitation +, good in 6 (8.0%) p atients with mitral regurgitation + + and/or mitral stenosis +, and po or in 6 (8.0%) patients with mitral regurgitation + + + and/or mitral stenosis + + . Two deaths (1.9%) occurred within the first 7 months of follow-up. Patients were evaluated clinically 1-67 months postoperati vely (mean 27): 90 (85.7 %) were in class I, 4 (3.8 %) in class II, 4 (3.8 %) in class III and 1 (1.0 %) in class IV. No follow-up was avail able in two (1.9 %) patients. The actuarial survival curve of the pati ents who were discharged from hospital shows a cumulative survival rat e of 98.0% after 60 months. We conclude that mitral valvuloplasty with the new prosthetic ring is an efficient method for surgical treatment of mitral valve incompetence.