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Ann Thorac Surg 1986;41:70-74
© 1986 The Society of Thoracic Surgeons

Articles

Left Ventricular Outflow Tract Obstruction with Mitral Valve Replacement in Small Ventricular Cavities

G. Kimble Jett, M.D., M. Denise Jett, B.A., M.T., Glenn R. Barnhart, M.D., Gerta L. van Rijk-Swikker, M.D., Michael Jones, M.D., Richard E. Clark, M.D.*

From the Surgery Branch, National Heart, Lung, and Blood Institute, Bethesda, MD

* Address reprint requests to Dr. Clark, Building 10, Room 2N242, National Institutes of Health, Bethesda, MD 20205

The inference that mitral valve replacement (MVR) may produce left ventricular outflow tract (LVOT) obstruction has been made, but no comparative hemodynamic studies with various types of prostheses have been done. The purpose of the present study was to compare the gradients created across the LVOT with MVR in young sheep with small left ventricular cavities. Mitral valve replacement was accomplished using cardiopulmonary bypass and hypothermic cardioplegic arrest. Five animals were used for each of the following valves studied: 25-mm Ionescu-Shiley bovine pericardial valve, 25-mm Hancock porcine aortic valve, 2M-6120 28-mm Starr-Edwards ball-valve prosthesis, 25-mm Björk-Shiley 60-degree flat tilting-disc prosthesis, and 25-mm St. Jude Medical hemidisc valve. Gradients across the LVOT were measured after MVR and then during infusion of isoproterenol hydrochloride (0.05 µ/kg/min). Following MVR, only the Starr-Edwards valve produced an LVOT gradient (32 ± 23 mm Hg). Substantial gradients after MVR were seen, however, with isoproterenol administration with the Ionescu-Shiley (47 ± 4 mm Hg), Hancock (13 ± 8 mm Hg), and Starr-Edwards (65 ± 30 mm Hg) valves but not with the low-profile valves (Björk-Shiley and St. Jude Medical). The results of the present study demonstrate that MVR can produce LVOT obstruction. The greatest degree of obstruction was with the high-profile mechanical and bioprosthetic valves.




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G. K. Jett, M. D. Jett, P. Bosco, G. L. van Rijk-Swikker, and R. E. Clark
Left Ventricular Outflow Tract Obstruction Following Mitral Valve Replacement: Effect of Strut Height and Orientation
Ann. Thorac. Surg., September 1, 1986; 42(3): 299 - 303.
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