Early And Midterm Results Of Double-orifice Technique For Mitral Regurgitation

Background: Mitral regurgitation is that the two pieces of mitral valve couldn't be closed in systolic period because the change of mitral structure involved in all kinds of diseases. The pathogenesis of mitral regurgitation consists of rheumatic disease, ischemic disease, congenital disease, infectious disease, degenerative disease and inherited disease etc. The surgical therapy style include mitral repair and mitral replacement with prostheses valve .Mitral replace procedure has been maturated and there is no mitral regurgitation after the procedure. But they need to take anticoagulation medicine for the patients accepted mitral replacement procedure .So there are some inevitable complications of anticoagulation medicine. For example, there is hemorrhage of all kinds of the tissue and organs in the whole body for the excessive dosage of anticoagulation medicine and embolism of all kinds of the tissue and organs in the whole body for the shortage dosage of anticoagulation medicine. There also consist of valve blocked, the leak of valve circumference, infectious endocarditis, hemolysis and the rupture of left ventricle. Mitral repair procedure rose lately and there were more procedures, but the post-operation effect couldn't confirmed. But also the post-operation effect is deeply correlated with the technique of operator .Mitral repair procedure not only has the lower embolism, no complications of anticoagulation and protecting the modality and function of left ventricle ,but also the patients could acquire better post-operation living quality. Especially, it adapt to the children because their heart are no maturity and the mitral valve annulus is very small. If we replace the smaller prostheses valve with the mitral valve ,the graft couldn't be adapted to the need of the children upgrowth .So we must replace the valve at second time. But the mitral repair procedure are not stable and need to reoperation. The basic requirements of mitral valve repair procedure is that reserving sufficient area of anterior leaflet of mitralvalve ,better activity of anterior leaflet of mitral valve and adequate veil interface area between anterior leaflet and posterior leaflet .Basing on the different parts and all kinds disease, the mitral repair technique consists of leaflet repair, chordal repair, annuloplasty and double-orifice technique ect. Alfieri applied the double-orifice technique to cure the mitral regurgitation at first in 1995.The technique is that they suture the midpoint of anterior and posterior leaflets together and format two hole in the mitral valve. It not only satisfied with the basic requirements of mitral valve repair procedure but also broke the traditional "single hole"definition in valve repair procedure. It simplified the surgery procedure and reserved useful tendon and papillary muscle. The key of the procedure is to search the point of regurgitation. The point of mitral regurgitation was not usually the midpoint of two leaflets because of the prolapse of anterior leaflet or posterior leaflet .So we must observe the regurgitation by affusion test again and again and adjust the fixup point .Therefore the area of two holes wasuncertainly symmetrical. Some research showed that the velocity of flow and pressure gradient were same with the physiology although the area of two holes was unsymmetrical. The velocity of flow and pressure gradient were unaffected with the size of the two holes under postoperation. So the double-orifice technique couldn't affect on the dynamics of blood streams. The double-orifice technique could resume the veil interface of anterior leaflet and posterior leaflet at closing .It could increase the veil interface to shrink the mitral annulus at the same time .Therefore we recommend applying the double-orifice technique with annuloplasty. But we must notice the relation between the degree of shrinking annulus and the hatch area of mitral valve. It is import to adjust the degree of shrinking annulus on the fact. Otherwise, only repairing the dilated annulus in the process of annuloplasty and no prefix thread ,you could acquire better effect and avoid the systolic anterior motion for the asymmetry of perfix thread or bad annuloplasty. The long time effect for the treatment waseffected by the hypertension of pulmonary artery ,severer dilation of left atrium and calcification of annulus . Objective: To evaluate the clinical effect of the double-orifice technique in the treatment of mitral regurgitation. Methods: Between November 2002 and November 2004 ,7 patients underwent mitral repair of double-orifice technique procedure. There were 3 male and 4 female patients. Their age was from 4 years old to 51 years old. There were 2 patients for rheumatic diseases,2 patients for ischemic disease,1 patients for congenital disease,2 patients with left atrium myxnoma.6 patients were anterior leaflet prolapse and 1 patients was posterior leaflet prolapse.6 patients were NYHA class II and 1 patient was NYHA class III. We used Echo-Doppler to evaluate and applied the coronary artery photograph to find out the complexation of coronary artery. Surgical technique: Mitral valve repair was performed during total hypothermic cardiopulmonary by-pass throughconventional midline sternotomy. Myocardial protection was accomplished by antegrade cold-blood cardioplegia. The mitral valve was accessed through the left atrium, after development of the interatrial groove. An intraoperative inspection of the valve was carried out to confirm pre-operative echocardiography findings and to identify the prolapse of anterior leaflet or posterior leaflet. We resected the posterior leaflet with cuniform for the patients with posterior leaflet prolapse at first and repaired the posterior leaflet with 6.0 Gore-Tex stitch. Placed one stitch with 4*12 undamaged thread in the middle of free edge of prolapse portion leaflet between anterior leaflet and posterior leaflet, and then applied effusion test to inspect the mitral closing. If the closing was not satisfied, adjust the stitch point to find out the best position.4 patients underwent annuloplasty with pericardiac belt .Tried the effusion test again to inspect the closing of mitral valve and expand the left ventricle if the closing was satisfied. Subsequently, observed the area ofmitral valve outlet(the area of mitral valve outlet should be no less than 3.0cm2).Assessed the function of mitral valve and the mitral oulet with transesphagus Echo-doppler after the heart repulsed and stopped the cardiopulmonary by-pass. Result: Mild regurgitation was found in 2 patients. There was no hospital death. The period of follow-up was from 5 months to 29 months. Except for 1 patient was lost in follow-up, the heart function of the other patients was improved significantly in all patients(NYHA class I).Echo-Doppler assessment of valve showed stable valve function in all patients. There were no later stenosis of valve and no late death. The mitral regurgitation of 7 patients decreased apparently。Applied the paired t-test to the cardiac Echo-doppler parameter of preoperation, intraoperation, postoperation of 7 patients , P<0.05 and this test was value. Conclusion: The results of this study suggested that the double-orifice technique is a safe and effective method for...