Isolated replacement of the mitral leaflets and 'Mercedes'-plastics of the giant left atrium: surgery for patients with left ventricle dysfunction and left atrium enlargement.

摘要

BACKGROUND: The main goal of the present surgery is to develop a new complex of surgical procedures for patients with long-standing mitral valve incompetence, severe left atrium (LA) and left ventricle (LV) enlargement (secondary cardiomyopathy). METHODS: Seven patients were operated on using a new technique. Normal LA shape and size were restored by symmetrical "Mercedes"-plastics of the posterior LA wall. Isolated strut chordae sparing mitral leaflets replacement (SChS-MLR) was performed for preserving annular-LV interaction and biomechanics of the LV contraction. In mitral position we implanted bileaflets Carbomedics (USA) prosthesis (in 6 patients) and a tilting disc MIKC prosthesis (Russia). Additionally RA plastics and TV De Vega plastics were performed in 4 patients. Diastolic and systolic functions of the LV, the size of the LA were under TEE and 2D ECHO controls. RESULTS: All the patients were discharged from the hospital. After the operation the needs for inotropic support were minimal. We did not see any local LV wall motion abnormalities. The end diastolic volume and long-axis dimension of the LV did not have any tendency to grow. CONCLUSIONS: New surgical technique of isolated SChS-MLR together with the symmetrical restoration of the LA shape and size can be equivalent to reconstructive mitral valve surgery from the hemodynamical point of view and allows us to standardize the surgical technique for those patients with significant left heart enlargement.