Echocardiographic evaluation of patients undergoing mitral valve replacement with crossed papillopexy

Abstract

Background: Techniques for mitral valve replacement with preservation of the subvalvular apparatus have proven their superiority, and crossed papillopexy is a new technical option which, besides allowing Preservation of the anatomical structures, provides contractility support and protection to the myocardium during ventricular diastole. The technique requires further studies that document its results.

Objective: To evaluate the left atrial and ventricular function by Doppler echocardiography in patients who have undergone mitral valve replacement with crossed papillopexy.

Methods: Fifteen patients underwent mitral valve replacement, 9 (60%) of them male, and the mean age was 45.7 years. As to the etiology of aortic valve disease, nine (60%) cases were degenerative, three (20%) were rheumatic, two (13.3%) were ischemic, and one patient (6.7%) had infectious endocarditis. After closure of the atriotomy and anatomical evaluation of the valvar apparatus, the anterior leaflet was detached from the annulus and centrally split in halves, each one with its complex tendinous chords attached to the opposing commissure by its medial extremity. Biological (13 cases) or mechanical prosthetic valves were implanted and secured with separate stitches. Reduction of the valvar annulus was performed in patients with dilated cardiomyopathy. Patients underwent clinical and Doppler echocardiographic examinations before surgery and six months after the procedure.

Results: All patients were clinically stable at discharge. A significant reduction in ventricular and atrial diameters was demonstrated (p< 0.001) without impairment of the entry and exit points of the left ventricle.

Conclusion: Mitral valve replacements performed with the crossed papillopexy technique showed favorable results with a positive effect on the recovery of left atrial and ventricular morphology.