Document Detail

The "physio-ring": an advanced concept in mitral valve annuloplasty.
MedLine Citation:
PMID:  8526596     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A new annuloplasty ring has been developed with the aim of adding flexibility to the remodeling annuloplasty concept. Here we report its clinical use with special emphasis on segmental valve analysis and valve sizing. METHODS: From October 1992 through June 1994, 137 patients aged 4 to 76 years (mean age, 49.1 years) were operated on. The main causes of mitral valve insufficiency were degenerative, 90; bacterial endocarditis, 15; and rheumatic, 13. The indication for operation was based on the severity of the mitral valve insufficiency (90 patients were in grade III or IV) rather than on functional class (60 patients were in class III or IV). At echocardiography 6 patients had normal leaflet motion (type I), 119 leaflet prolapse (type II), and 12 restricted leaflet motion (type III). Surgical repair was carried out using Carpentier techniques of valve reconstruction. In 3 patients, inadequate ring sizing was responsible for systolic anterior motion of the anterior leaflet diagnosed by intraoperative echo. The valve was replaced in 2 patients. There were three hospital deaths, no late deaths, one reoperation for recurrent mitral valve insufficiency due to chordal rupture 1 month after repair, one reoperation for atrial thrombus formation 5 months after repair, one anticoagulant-related hemorrhage, and one thromboembolic episode. RESULTS: Mid-term follow-up between 6 and 18 months was available in 94 patients. Echocardiography showed trivial or no regurgitation in 93.2% of the patients and minimal regurgitation in 6.8%. The average transmitral diastolic gradient was 3.55 +/- 1.93 mm Hg. Left ventricular end-systolic diameter and volume decreased postoperatively, demonstrating an improved left ventricular function. CONCLUSIONS: This preliminary experience has provided promising results and allowed us to define the indications of the Physio-Ring versus the classic ring. It has also shown that valve sizing and proper ring selection are of primary importance.
A F Carpentier; A Lessana; J Y Relland; E Belli; S Mihaileanu; A J Berrebi; E Palsky; D F Loulmet
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  60     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1995 Nov 
Date Detail:
Created Date:  1996-01-22     Completed Date:  1996-01-22     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1177-85; discussion 1185-6     Citation Subset:  AIM; IM    
Department of Cardiovascular Surgery and Organ Transplantation, H?pital Broussais, Paris, France.
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MeSH Terms
Child, Preschool
Follow-Up Studies
Heart Valve Prosthesis* / adverse effects
Hospital Mortality
Middle Aged
Mitral Valve Insufficiency / classification,  etiology,  surgery*,  ultrasonography
Monitoring, Intraoperative
Prosthesis Design
Severity of Illness Index
Stroke Volume

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