Mitral Annuloplasty with the Puig Massana-Shiley Ring: Long-Term Results
The use of mitral annuloplasties is increasing. Since 1977 we have employed an original flexible and adjustable ring to increase the reliability of such operations. A total of 314 rings were implanted until 1986, 237 in the mitral valve and 77 in the tricuspid valve.
The ring is adjusted until the mitral valve becomes competent. It is checked with a perfusion catheter in the left ventricle. We do not reduce the diameter of the mitral valve orifice under 23 mm
We review the long-term results in the group with isolated mitral valve disease (168 patients). The regurgitation was pure in 56 patients (33%). The hospital mortality was zero. The symptomatic improvement was good. Only three cases remain in NYHA class III. The actuarial curves show an 83% survival rate at 8 years, and 91% of the patients are free of thromboembolism.
The echocardiographic studies show a significant reduction in the left ventricular diameter. In the postoperative cardiac catheterization, we observed a decrease in the mean pulmonary artery pressure, wedge pressure, volumes of the left ventricle and mitral regurgitation which were more significant in the nonrheumatic group of patients.
The actuarial and pre- and postoperative studies suggest that this method is a good alternative in the surgical treatment of the mitral incompetence. It can usually be corrected if the anterior mitral leaflet is not severely damaged. In our experience, an adjustable ring makes complete repair easier than any other techniques.
KeywordsMitral Valve Mitral Regurgitation Mitral Valve Disease Pulmonary Artery Wedge Pressure Mitral Insufficiency
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