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Early Outcome of Mitral Valve Replacement: Results from Chordal Preservation at Muhimbili National Hospital, Tanzania
Ussiri, E.V.; Wandwi, W.B.C.; Nyawawa, E.T.M.; Nyangassa, B.J.; Kamala, B.A.; Satyaki, N. & Mahalu, W.
Abstract
Background:
Mitral Valve Replacement (MVR) is a common procedure for chronic
Rheumatic Heart Disease (RHD) in developing countries. MVR may involve excision of
chordae tendinae with leaflet(s) depending on the extent of pathology. Follow up of these
patients reveals a progressive Left Ventricle (LV)
dilatation, LV dysfunction and low cardiac
output syndrome which has been attributed to the loss of annulo-ventricular continuity.
Many studies revealed that, preservation of chordae
tendinae has a significant role in
maintaining post –operative normal LV size and function. The main objective of this study
was to determine early outcome of mitral valve replacement among patients operated for
Mitral Valve Replacement (MVR) with regards to chordal preservation at Muhimbili
National Hospital
Patients and Methods:
All patients admitted in the Cardiothoracic Unit, Muhimbili National
Hospital for Mitral Valve Replacement from November
2011 to November 2013. Detailed
echo was done pre-and post- operatively and New York Heart Association class (NYHA)
assessment were recorded. Intra-operative valve assessment was done and categorized
into; Total Chordal Excision (TCE), Posterior Mitral Leaflet (PML) preservation or Total
Chordal Preservation (TCP). Patients were followed
up at one month for control echo and
NYHA assessment
Results:
A total of 59 patients were recruited, male accounting for 31.7% and female 68.3%
with age ranging from 10 years to 58 years. Indications for surgery were; severe mitral
valve stenosis (MS)-33.2%, severe mitral valve regurgitation (MR)-35.6% and severe mixed
mitral valve disease (MMVD)-32.2%. Among all patients, 45.8% had calcified leaflet(s) and
30.55% had atrial fibrillation. TCE was done in 22
patients (37.3%), PML in 21 patients
(35.6%) and TCP in 16 patients (27.1%). There was a
significant increase in End Diastolic
Volume (EDV) and End Systolic Volume (ESV) with decrease in Ejection Fraction (EF) post-operatively in the TCE group (p=0.024, 0.001 and 0.000 respectively), a significant decrease
in EDV and ESV in PML preservation (p=0.001 and 0.002 respectively), increase in EF
(p=0.004) and a significant decrease in EDV in TCP
group (p=0.008), increase in EF
(p=0.016).
Conclusion and Recommendation
•Chordal Preservation in chronic rheumatic Mitral Valve Replacement is encouraged
•Chordal Preservation plays a significant role in the reduction of Left Ventricular
volumes and improvement in ventricular function
•A larger scale study with longer follow up is required
Keywords
Mitral Valve Replacement; Chordal Preservation; Early Outcome
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