Malpartida TF, Vivancos DR, Fernández Madero G

Language: Spanish
References: 11
Page: 312-315
PDF size: 52.97 Kb.

ABSTRACT

Knowledge of the natural history of mitral valve disease means that patients who are asymptomatic, or minimally symptomatic, can undergo surgery to improve their prognosis. Accordingly, a full history and physical examination should be performed to determine the functional status, as well as chest radiography and an electrocardiogram to complete the initial evaluation before deciding on treatment. Echocardiography is the most important non-invasive technique for evaluating the hemodynamic repercussions and valve anatomy. Evaluation of mitral valve stenosis should include the mean gradient, valve area and, most importantly, a detailed study of the valve morphology, to select the best possible candidates for surgery, which is percutaneous mitral valvulotomy. Follow-up over 8 years of 220 patients after percutaneous mitral valvulotomy showed that adverse events were related with an age › 56 years, the presence of atrial fibrillation and an echocardiographic score › 9. Evaluation of mitral incompetence should include symptomatic repercussions, as the possibility of repair exists in barely symptomatic patients, to prevent left ventricular dysfunction, which is the main factor influencing prognosis. An almost perfect repair requires prior selection of patients with an echocardiographic study, which enables recognition of the etiology and mechanism of the mitral incompetence and posterior control with intraoperative transesophageal echocardiography. In our experience, as in that of many others, it is more feasible to repair prolapse of the posterior valve (100% of our cases) than the anterior valve (25% of our cases).

REFERENCES

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