Careaga RG, Martínez CG, Argüero SR

Language: Spanish
References: 9
Page: 88-91
PDF size: 52.55 Kb.

ABSTRACT

Objective: To inform about our experience in the treatment of the ischemic mitral regurgitation. Material and methods: We reviewed the files of patients with ischemic mitral regurgitation treated between January 1, 2000 and May 31, 2005. We analyzed grade of mitral regurgitation, coronary vessels affected, clinical and hemodynamic conditions according NYHA, Canadian Cardiovascular Classification and Parsonet operative risk scale. Also were evaluated the surgical procedure with its results, morbidity, mortality and length of stay in Intensive Care Unit and in hospital. Results: During that time period, 24 patients were treated (10 females and 14 males) with a mean age of 68.9 ± 8.56 years old. In nine cases the mitral regurgitation was moderated and in 15 was severe i.e. preoperative ejection fraction was 55.8 ± 12.7%. The main surgical procedure was mitral valve replacement with ischemic time of 82 ± 29 minutes, and cardiopulmonary bypass of 120 ± 40.5 minutes. Eight patients had postoperative complications and 2 died. The main complication was of respiratory kind followed by perioperative myocardial infarction. The intensive care unit length of stay was 7.7 ± 4 days, and total length of stay in hospital was 16.6 ± 7.28 days. Conclusion: In patients in whom the surgical treatment of ischemic mitral regurgitation is well established, we obtain clinical improvement and better survival.

REFERENCES

1. Kaul S, Spotnitz WD, Glasheen WP, Touchstone DA. Mechanism of ischemic mitral regurgitation: an experimental evaluation. Circulation 1991; 84: 2167-2180.

2. Paparella D, Mickelborough LL, Carson S, Ivanov J. Mild to moderate mitral regurgitation in patients undergoing coronary bypass grafting: effects on operative mortality and longterm significance. Ann Thorac Surg 2003; 76: 1094-1100.

3. Fasol R, Lakew F, Wetter S. Mitral repair in patients with a ruptured papillary muscle. Am Heart J 2000; 139: 549-554.

4. Badhwar V, Bolling SF. Mitral regurgitation and the ischemic heart. In: Yang SC, Cameron DE, eds. Current therapy in thoracic and cardiovascular surgery. Mosby Inc. USA. 2004: 672-674.

5. Vlodaver Z, Edwards JE. Rupture of ventricular septum or papillary muscle complicating myocardial infarction. Circulation 1977; 55: 815.

6. Harold JG, Bateman TM, Czer LS, Chaux A, Matloff JM, Gray RJ. Mitral valve replacement early after myocardial infarction attendant high risk of left ventricular rupture. J Am Coll Cardiol 1987; 9: 277.

7. Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Kirklin/Barrat-Boyes Cardiac Surgery 3rd ed. Chapter 10 Mitral regurgitation from ischemic heart disease. Churchill-Livingstone. USA. 2003: 472- 479.

8. Gillinov AM, Wierup PN, Blackstone EH, Bishay ES, Cosgrove DM, White J et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 2001; 122: 1125.

9. Hausmann H, Siniawski H, Hetzer R. Mitral valve reconstruction and replacement for ischemic mitral insufficiency: seven years’ follow up. J Heart Valve Dis 1999; 8: 536.