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Title: Five Year Experience of Mitral Valve Repair Surgery at Armed Force Institute of Cardiology
Authors: Nasir Ali, Rehan Masroor, Muhammad Afsheen Iqbal, Syed Muzaffar Hasan Kirmani, Hannah Khurshid, Muhammad Adnan Akram
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2022
Volume: 72
Issue: Supplementary 3
Language: English
DOI: 10.51253/pafmj.v72iSUPPL-3.9552
Keywords: Mitral regurgitationMitral valve annuloplastyRheumatic Mitral valve diseaseMitral valve repair
Objective: Experience of the conventional and a de novo Mitral repair techniques for the treatment of Severe Mitral Regurgitation (MR) in a Tertiary Care Cardiac Hospital of Pakistan.
Study Design: Descriptive cross sectional
Place and Duration of Study: Cardiac Surgical Division, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, Pakistan
Methodology: This was a cross sectional study conducted over a period of 5 years from 2016 to 2020, which included SeventyFive (n=75) patients in the trial, 55 females and 20 males. The mean age was 23±9.5 years (range from 16 to 52 years). Amongst all cases of mitral regurgitation (MR) were five (6%) myxomatous degenerative changes, three (4%) ischemic MR & Sixtyseven (91%) patients had rheumatic aetiology. Five (05) patients with myxomatous diseases required only ring annuloplasty. In patients with ischemic MR, two required chordal shortening for anterior leaflet resuspension, and one required quadrangular resection of the posterior leaflet. Restrictive annuloplasty±Coronary Artery Bypass Grafting (CABG) was alsoperformed as part of the procedures. Sixty-seven (91%) patients having severe Mitral Regurgitation with rheumatic aetiology, required a myriad of procedures; including neo-chordae suspension for anterior & posterior mitral leaflets, quadrangular resection & reattachment of the posterior mitral leaflet. A novel innovative procedure, “Posterior annulus-sliding-plasty” (Nasir’s Technique) was adopted in patients with relatively fixed posterior mitral leaflet. Semi-rigid rings (Carbomedics® or Medtronic CG future®) were used in all the patients to stabilize our repair.
Results: There was no operative mortality. Patients were followed up for 01-year. Most of the patients have been found to have adequate intact Mitral Valve Repair. Only 01 patient developed Grade-II MR after 06 months (ischemic aetiology). This patient is being followed up at 06 monthly intervals with transthoracic echo and is being treated as per guideline-directed medical therapy (GMDT) for functional MR.
Conclusion: Mitral Valve Repair in the carefully selected subset of patients with severe MR, irrespective of aetiology can effectively be treated with satisfactory short-term and medium-term results.
To evaluate the experience of conventional and novel mitral repair techniques for severe mitral regurgitation in a tertiary care cardiac hospital in Pakistan.
A descriptive cross-sectional study conducted over five years (2016-2020) involving 75 patients (55 females, 20 males) with severe mitral regurgitation. Patients underwent various repair procedures based on the etiology (myxomatous, ischemic, rheumatic), including ring annuloplasty, chordal shortening, quadrangular resection, and a novel "Posterior annulus-sliding-plasty" (Nasir's Technique). Semi-rigid annuloplasty rings were used for stabilization. Pre-operative assessment included transthoracic and trans-esophageal echocardiography.
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Mitral valve repair is considered the gold standard for mitral regurgitation. The study highlights the evolution of mitral valve repair programs, the importance of intra-operative transesophageal echocardiography for assessing pathology and guiding repair, and the development of institutional guidelines and innovations for sustained and predictable repair, particularly in rheumatic mitral valve disease.
There was no operative mortality. Follow-up for one year showed adequate intact mitral valve repair in most patients. One patient with ischemic etiology developed Grade-II MR after six months and is being managed medically.
Mitral valve repair is an effective treatment for carefully selected patients with severe mitral regurgitation, irrespective of etiology, yielding satisfactory short-term and medium-term results. A dedicated team with expertise in valve repair and echocardiography is recommended.
1. Study Duration: The study was conducted over a period of 5 years from 2016 to 2020. (Confirmed in Methodology section).
2. Patient Demographics: The study included 75 patients, with 55 females and 20 males. (Confirmed in Methodology section).
3. Rheumatic Etiology Prevalence: 91% of patients had rheumatic aetiology for severe mitral regurgitation. (Confirmed in Methodology section).
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