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

This Article 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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cheng, T. O. Search for Related Content PubMed PubMed Citation Articles by Cheng, T. O.

J Thorac Cardiovasc Surg 2000;119:634
© 2000 Mosby, Inc.

LETTERS TO THE EDITOR

Combined mitral valve repair and the Cox maze procedure for mitral valve prolapse and regurgitation and associated atrial fibrillation

Professor of Medicine The George Washington University, Washington, DC 20037

To the Editor:

I read with great interest the report by Handa and associates ¹ on the early and intermediate term results of combined mitral valve repair and the Cox maze procedure for patients with severe mitral regurgitation and associated atrial fibrillation. It is gratifying to note that at the Mayo Clinic the addition of the Cox maze procedure to mitral valve repair not only is safe and effective but also decreases late complications.

One of the serious complications of mitral valve prolapse, which is otherwise a common ² and benign ³ condition, is mitral regurgitation. ^4,5 In fact, the commonest cause of mitral regurgitation in the United States is mitral valve prolapse. ^5,6 Mitral regurgitation in mitral valve prolapse may become progressive in some patients. ⁵ One of the serious complications of progressive mitral regurgitation is atrial fibrillation, which usually persists even after successful corrective surgery of the mitral valve and often recurs after pharmacologic or electric cardioversion. Although postoperative atrial fibrillation can be successfully managed by antiarrhythmic drugs and long-term anticoagulant therapy to prevent thromboembolism, these therapeutic modalities are not without side-effects, torsades de pointes and bleeding, respectively. It is gratifying that the adjunctive Cox maze procedure at the Mayo Clinic increased the restoration of sinus rhythm to 82% of their patients.

Therefore, as the authors concluded, "Although the addition of the Cox maze procedure lengthens hospital stay in patients having mitral valve repair, overall medical costs may be decreased by reducing the need for long-term anticoagulation, as well as costs associated with stroke and bleeding complications." ¹

doi:10.1067/mtc.2000.104693

References

1. Handa N, Schaff HV, Morris JJ, Anderson BJ, Kopecky SL, Enriquez-Sarano M. Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation. J Thorac Cardiovasc Surg 1999;118:628-35.[Abstract/Free Full Text]
   
2. Cheng TO, Barlow JB. Mitral valve leaflet billowing and prolapse: its prevalence around the world. Angiology 1989;40:77-87.
   
3. Barlow JB, Cheng TO. Mitral valve billowing and prolapse. In: Cheng TO. The International Textbook of Cardiology, New York/Oxford: Pergamon Press; 1987. p. 497-524.
   
4. Cheng TO. Mitral valve prolapse. Dis Month 1987;33:481-534.
   
5. Cheng TO. Mitral valve prolapse: an overview. J Cardiol 1989;19 (Suppl 21):3-20.
   
6. Cheng TO. Mitral-valve prolapse. N Engl J Med 1999;341:1471-2.[Free Full Text]
   

This Article 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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cheng, T. O. Search for Related Content PubMed PubMed Citation Articles by Cheng, T. O.