Isolated replacement of the mitral leaflets and Mercedes"-plastics of the giant left atrium: Surgery for patients with left ventricle dysfunction andleft atrium enlargement

Background. The main goal of the present surgery is to develop a new comple x of surgical procedures for patients with long-standing mitral valve incom petence, severe left atrium (IA) and left ventricle (UV) enlargement (secon dary cardiomyopathy). Methods. Seven patients were operated on using a new technique. Normal LA s hape and size were restored by symmetrical "Mercedes"-plastics of the poste rior LA wall. Isolated strut chordae sparing mitral leaflets replacement (S ChS-MLR) was performed for preserving annular-LV interaction and biomechani cs of the IV contraction. In mitral position we implanted bileaflets Carbom edics (USA) prosthesis (in 6 patients) and a tilting disc MIKC prosthesis ( Russia). Additionally RA plastics and TV De Vega plastics were performed in 4 patients. Diastolic and systolic functions of the LV, the size of the LA were under TEE and 2D ECHO controls. Results. All the patients were discharged from the hospital. After the oper ation the needs for inotropic support were minimal. We did not see any loca l IV wall motion abnormalities. The end diastolic volume and long-axis dime nsion of the IV did not have any tendency to grow. Conclusions. New surgical technique of isolated SChS-MLR together with the symmetrical restoration of the LA shape and size can be equivalent to recon structive mitral valve surgery from the hemodynamical point of view and all ows us to standardize the surgical technique for those patients with signif icant left heart enlargement.