Detection of mechanisms of immediate failure by transesophageal echocardiography in quadrangular resection mitral valve repair technique for severe mitral regurgitation
Section snippets
Study population
From January 2000 to December 2001, 206 consecutive patients with a diagnosis of prolapse or flail of the posterior leaflet underwent mitral valve repair. Of these patients, 205 underwent the quadrangular resection technique. These patients represent the study population group evaluated retrospectively (Table 1).
Surgical technique
The operations were performed by 3 surgeons (FM, LT, and OA). After midline sternotomy, cardiopulmonary bypass was instituted. Myocardial protection was obtained by cold blood
Results
Of the 205 patients submitted to quadrangular resection, 24 (11%) had immediate failure of the repair. The incidence of failure was not related to the surgeon who performed the operation or to the technique adopted (sliding vs no sliding plasty). Reinstitution of cardiopulmonary bypass (second pump run) was considered appropriate in 21 patients (10%) for further mitral valve surgery and in 2 patients (1%) exclusively to improve left ventricular function and eliminate MR (Figure 1). One patient
Discussion
By assessing leaflet motion, the origin and direction of the MR jet and left ventricular function were identified as most of the mechanisms of failure, with good agreement after surgery. As a first step in evaluating reasons for failure, one should rule out functional causes, such as left ventricular dysfunction and left ventricular outflow tract obstruction, because they are pharmacologically treatable conditions that do not need further surgical revision. However, despite these considerations
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