HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Neeraj Mediratta Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mediratta, N. Articles by Sosnowski, A. W. Search for Related Content PubMed Articles by Mediratta, N. Articles by Sosnowski, A. W.

Ann Thorac Surg 1998;65:1840
© 1998 The Society of Thoracic Surgeons

---

Correspondence

Total Preservation of Subvalvular Apparatus During Mitral Valve Replacement

^a Department of Cardiac Surgery, Glenfield Hospital NHS Trust, Groby Rd, Leicester, LE3 9QP, United Kingdom

To the Editor

We read with great interest the article by Dr Choh in the July 1997 issue of The Annals of Thoracic Surgery [1] and would like to share our own experience.

We have been using an identical technique for total preservation of the subvalvar apparatus during mitral valve replacements since 1992, having adapted this method from the description by Sintek and associates [2] and others. We presented our results as a poster at the last meeting of the Society for Cardiothoracic Surgeons of Great Britain and Ireland in Dublin, Ireland, in March 1997. Our series comprised 70 consecutive, unselected patients undergoing mitral valve replacements for degenerative, rheumatic, or ischemic pathology and included all stenotic, regurgitant, and mixed mitral valves. Also included were patients who had had closed mitral valvotomies previously, but we clearly had to exclude redo mitral valve replacements owing to the absence of all or part of the subvalvar apparatus after the first operation. Like Dr Choh we successfully implanted both bileaflet and tilting-disc mechanical valves as well as bioprostheses with this technique. Our hospital mortality was only 2.8% and, with echocardiographic follow-up available in more than half our patients, there were no cases of malfunction of the prosthetic valves caused by retained chordae and no cases of obstruction of the left ventricular outflow tract. It is unclear from Dr Choh’s article whether his 15 patients were a selected group, as it is implied they all had severe mitral regurgitation. In our series of 70 unselected, consecutive patients, 13% had pure mitral stenosis and more than half had mixed disease. We would therefore like to emphasize that with this technique total preservation of the subvalvar apparatus is safe and possible in nearly all mitral conditions and allows virtually all types of mechanical and tissue valves to be implanted.

References

1. Choh J.H. Preservation of anterior and posterior leaflet in mitral valve replacement with a tilting-disc valve. Ann Thorac Surg 1997;64:271-273.[Abstract/Free Full Text]
2. Sintek C.F., Pfeffer T.A., Kochamba G.S., Khonsari S. Mitral valve replacement: technique to preserve the subvalvular apparatus. Ann Thorac Surg 1995;59:1027-1029.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Neeraj Mediratta Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mediratta, N. Articles by Sosnowski, A. W. Search for Related Content PubMed Articles by Mediratta, N. Articles by Sosnowski, A. W.