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ORIGINAL ARTICLE

Experience with two techniques for valve replacement: I. Prosthesis with preservation of the valvar elements. II. Valvar repair with reconstruction and advancement of the posterior leaflet

Paulo Roberto Barbosa Evora; Paulo José de Freitas Ribeiro; José Carlos Franco Brasil; Adónis Garcia Otaviano; Celso Luis dos Reis; Hércules Lisboa Bongiovani; Rubio Bombonato; Marcus Antônio Ferez; Antônio Carlos Menardi; Ricardo Nilsson Sgarbieri

DOI: 10.1590/S0102-76381988000100005

ABSTRACT

The continuity between mitral valve and the left ventricular wall through chordae tendinae and papillary muscles plays a role in left ventricular function. The morbity and mortality for mitral valve replacement remain much higher than other cardiac procedures such as aortic valve replacement, mitral valvuloplasty and coronary artery bypass grafts. These facts justify all possible studies related to the correction of mitral valve insufficiency. The present paper presents our experience with two techniques for correction of mitral valve insufficiency: valve replacement with preservation of the mitral apparatus components and valvuloplasty by the reconstruction and advancement leaflet. Our main concern was the surgical details and ventricular function studies were not performed. Various techniques to maintain continuity of the mitral valve annulus and the ventricular musculature, when valve replacements is mandatory, are presented. The importance of the reconstruction and advancement of the posterior leaflet, alone or associated with other repair techniques such as comissurotomy, annuloplasty and shortening of chordae tendinae, is emphasized.

RESUMO

Na integridade funcional do ventrículo esquerdo, é importante a continuidade entre a valva mitral e a parede ventricular mantida pelas cordas tendíneas e os músculos papilares. Por outro lado, além de maior mortalidade cirúrgica da insuficiência mitral, quando comparada com as próteses aórticas e a revascularização do miocárdio, observa-se menor morbi-mortalidade nos casos de valvoplastias em relação às próteses mitrais. Estes fatos constituem um desafio para a moderna cirurgia cardíaca, justificando-se todos os esforços de ampliação dos estudos no tratamento do refluxo valvar, tanto pelas correções plásticas, como pelo implante de prótese. No presente trabalho, apresenta-se a experiência com dois tipos de técnicas para o tratamento cirúrgico da insuficiência mitral: prótese com preservação de elementos do sistema valvar e plastia valvar com ampliação e avanço da cúspide posterior. Preocupou-se mais com os detalhes cirúrgicos, não tendo sido realizados estudos da função ventricular esquerda. Apresentam-se as diversas táticas para garantir a continuidade entre o anel valvar e parede do ventrículo nas trocas valvares. Ressalta-s a importância, nem sempre lembrada, da ampliação da cúspide posterior e a sua associação com outras técnicas de plastias valvares, tais como: comissurotomias, papilarotomias, anuloplatias e encurtamento de cordas tendíneas.
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