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The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 718-725, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TE David, RJ Burns, CM Bacchus and MN Druck
Left ventricular function was compared in 15 patients who had conventional
mitral valve replacement (Group 1) and 12 patients who had replacement with
preservation of chordae tendineae and papillary muscles (Group 2) for
isolated chronic mitral regurgitation. Function was assessed by
radionuclide ventriculography. The two groups were similar in terms of age,
preoperative functional class, valve pathology, and preoperative left
ventricular function. There was uniform intraoperative and postoperative
management by a single surgeon. All patients received porcine
bioprostheses. Left ventricular function was assessed 1 day before and 3 to
6 months after the operation. Left ventricular ejection fraction decreased
from 0.55 +/- 0.09 to 0.48 +/- 0.14 in Group 1 (p less than 0.01) and did
not change significantly in Group 2 (from 0.53 +/- 0.14 to 0.52 +/- 0.16).
Left ventricular end-diastolic volume, end-systolic volume, and stroke
volume indices decreased significantly in both groups. During maximal
postoperative bicycle exercise with the patient supine, left ventricular
ejection fraction and stroke volume index increased significantly in Group
2 only. Cardiac output increased in both groups during exercise, but this
increase was due to increased heart rate in Group 1 and to increased heart
rate and stroke volume in Group 2. These findings suggest that preservation
of chordae tendineae and papillary muscles during mitral valve replacement
for chronic mitral regurgitation has a beneficial effect on postoperative
left ventricular function.
ARTICLES
Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae
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T. A. Timek, S. L. Nielsen, G. R. Green, P. Dagum, A. F. Bolger, G. T. Daughters, J. M. Hasenkam, N. B. Ingels Jr, and D. C. Miller Influence of anterior mitral leaflet second-order chordae on leaflet dynamics and valve competence Ann. Thorac. Surg., August 1, 2001; 72(2): 535 - 540. [Abstract] [Full Text] [PDF]
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H. M. Spotnitz Macro design, structure, and mechanics of the left ventricle J. Thorac. Cardiovasc. Surg., May 1, 2000; 119(5): 1053 - 1077. [Full Text] [PDF]
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K. L. Yun, C. F. Sintek, D. C. Miller, G. T. Schuyler, A. D. Fletcher, T. A. Pfeffer, G. S. Kochamba, S. Khonsari, and M. R. Zile Randomized Trial of Partial Versus Complete Chordal Preservation Methods of Mitral Valve Replacement : A Preliminary Report Circulation, November 9, 1999; 100(90002): II-90 - II-94. [Abstract] [Full Text] [PDF]
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M. R. Moon, A. DeAnda Jr, G. T. Daughters II, N. B. Ingels Jr, and D. C. Miller Effects of mitral valve replacement on regional left ventricular systolic strain Ann. Thorac. Surg., September 1, 1999; 68(3): 894 - 902. [Abstract] [Full Text] [PDF]
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J.-P. Remadi, P. Bizouarn, O. Baron, O. Al Habash, P. Despins, J.-L. Michaud, and D. Duveau Mitral valve replacement with the St. Jude medical prosthesis: a 15-year follow-up Ann. Thorac. Surg., September 1, 1998; 66(3): 762 - 767. [Abstract] [Full Text] [PDF]
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D. Skudicky, M. R. Essop, and P. Sareli Time-Related Changes in Left Ventricular Function After Double Valve Replacement for Combined Aortic and Mitral Regurgitation in a Young Rheumatic Population: Predictors of Postoperative Left Ventricular Performance and Role of Chordal Preservation Circulation, February 18, 1997; 95(4): 899 - 904. [Abstract] [Full Text]
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V. Rao, M. Komeda, R. D. Weisel, J. Ivanov, J. S. Ikonomidis, T. Shirai, and T. E. David Results of Represervation of the Chordae Tendineae During Redo Mitral Valve Replacement Ann. Thorac. Surg., July 1, 1996; 62(1): 179 - 183. [Abstract] [Full Text]
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M. Natsuaki, T. Itoh, S. Tomita, K. Furukawa, M. Yoshikai, H. Suda, and H. Ohteki Importance of Preserving the Mitral Subvalvular Apparatus in Mitral Valve Replacement Ann. Thorac. Surg., February 1, 1996; 61(2): 585 - 590. [Abstract] [Full Text]
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Y. Takayama, J. W. Holmes, I. LeGrice, and J. W. Covell Enhanced Regional Deformation at the Anterior Papillary Muscle Insertion Site After Chordal Transsection Circulation, February 1, 1996; 93(3): 585 - 593. [Abstract] [Full Text]
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M. Komeda, A. DeAndar Jr, J. R. Glasson, A. F. Bolger, Y. Tomizawa, G. T. Daughters II, T. L. Tye, N. B. Ingels Jr, and D. C. Miller Exploring better methods to preserve the chordae tendineae during mitral valve replacement Ann. Thorac. Surg., December 1, 1995; 60(6): 1652 - 1658. [Abstract] [PDF]
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A. DeAnda Jr, M. Komeda, S. D. Nikolic, G. T. Daughters II, N. B. Ingels, and D. C. Miller Left Ventricular Function, Twist, and Recoil After Mitral Valve Replacement Circulation, November 1, 1995; 92(9): 458 - 466. [Abstract] [Full Text]
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H. Uemura, R. H. Anderson, S. Y. Ho, W. A. Devine, W. H. Neches, A. Smith, T. Yagihara, and Y. Kawashima LEFT VENTRICULAR STRUCTURES IN ATRIOVENTRICULAR SEPTAL DEFECT ASSOCIATED WITH ISOMERISM OF ATRIAL APPENDAGES COMPARED WITH SIMILAR FEATURES WITH USUAL ATRIAL ARRANGEMENT J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 445 - 452. [Abstract] [Full Text]
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T. J. Vander Salm, L. A. Pape, and J. F. Mauser Mitral valve replacement with complete retention of native leaflets Ann. Thorac. Surg., January 1, 1995; 59(1): 52 - 55. [Abstract] [PDF]
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M. R. Moon, A. DeAnda Jr, G. T. Daughters II, N. B. Ingels Jr, and D. C. Miller Experimental evaluation of different chordal preservation methods during mitral valve replacement Ann. Thorac. Surg., October 1, 1994; 58(4): 931 - 944. [Abstract] [PDF]
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M. Nagatsu, K. Ishihara, M. R. Zile, H. Tsutsui, H. Tagawa, G. DeFreyte, R. Tanaka, G. Cooper IV, and B. A. Carabello The effects of complete versus incomplete mitral valve repair in experimental mitral regurgitation J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 416 - 423. [Abstract] [Full Text]
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E. Gams, S. Hagl, H. Schad, W. Heimisch, N. Mendler, and F. Sebening Importance of the mitral apparatus for left ventricular function: an experimental approach Eur J Cardiothorac Surg, January 1, 1992; 6(Supplement_1): S17 - S24. [Abstract] [PDF]
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D. H. Harpole Jr, J. S. Rankin, W. G. Wolfe, F. M. Clements, P. Van Trigt, W. G. Young, and R. H. Jones Effects of standard mitral valve replacement on left ventricular function Ann. Thorac. Surg., June 1, 1990; 49(6): 866 - 874. [Abstract] [PDF]
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T. E. David, M. Komeda, C. Pollick, and R. J. Burns Mitral valve annuloplasty: The effect of the type on left ventricular function Ann. Thorac. Surg., April 1, 1989; 47(4): 524 - 528. [Abstract] [PDF]
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M. Azariades and S. C. Lennox Rupture of the Posterior Wall of the Left Ventricle after Mitral Valve Replacement: Etiological and Technical Considerations Ann. Thorac. Surg., November 1, 1988; 46(5): 491 - 494. [PDF]
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S. Miki, K. Kusuhara, Y. Ueda, M. Komeda, Y. Ohkita, and T. Tahata Mitral Valve Replacement with Preservation of Chordae Tendineae and Papillary Muscles Ann. Thorac. Surg., January 1, 1988; 45(1): 28 - 34. [Abstract] [PDF]
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K. H. Teoh, G. T. Christakis, R. D. Weisel, C. P. Tong, L. L. Mickleborough, H. E. Scully, B. S. Goldman, and R. J. Baird The Determinants of Mortality and Morbidity after Multiple-Valve Operations Ann. Thorac. Surg., April 1, 1987; 43(4): 353 - 358. [Abstract] [PDF]
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T. E. David Mitral Valve Replacement with Preservation of Chordae Tendinae: Rationale and Technical Considerations Ann. Thorac. Surg., June 1, 1986; 41(6): 680 - 682. [Abstract] [PDF]
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P. A. Spence, C. M. Peniston, T. E. David, N. Mihic, A. K. Jabr, P. Narini, and T. A. Salerno Toward a Better Understanding of the Etiology of Left Ventricular Dysfunction after Mitral Valve Replacement: An Experimental Study with Possible Clinical Implications Ann. Thorac. Surg., April 1, 1986; 41(4): 363 - 371. [Abstract] [PDF]
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