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Preservation of subvalvular mitral valve replacement is not a new concept, but clinical effect on the surgical and adopted to retain the subvalvular surgical methods to get a better short-term and long-term clinical effects remains controversial . In 1961, the first cases of mitral valve replacement (Starr-Edwards) was reported, was the total removal of the tip of the mitral valve leaflets, chordae and papillary muscles, early mitral valve replacement with higher mortality and postoperative low cardiac output and other serious complications, but with the revised MVR surgical indications, and to improve the methods of myocardial protection, expand the range of applications can not be repaired and retained mitral valve repair surgery cases mitral structure, the incidence of postoperative low cardiac output gradually reduced. The mitral subvalvular of including the left ventricular free wall, both papillary muscles and their tendons. Before and after papillary muscle issued tendons connected to the mitral valve anterior lobe and Next. The progressive deterioration of left ventricular function in patients with chronic mitral regurgitation, continues to damage of the left ventricular systolic function and left ventricular diastolic filling pressure increased. Subsequently, many compared reserved and does not retain the structure of clinical trials in the mitral valve Hint: preservation of subvalvular mitral postoperative left ventricular rupture, keeping the left ventricular continuity. To reduce paravalvular leakage, and to maintain the left ventricular systolic and diastolic function reflects the advantage. Objective: To summarize the 36 cases of mitral valve replacement (MVR) to retain the subvalvular the method and technical points; evaluation of the impact of early postoperative left ventricular contraction, pumping function; explore the potential complications. Method: Select the period January 2007 to December 2009 in the Second Affiliated Hospital of Dalian Medical University accepted 36 operated patients retained all flap structure, including 20 males and 16 females, aged 64-82 years old, mitral The lesions are chronic severe mitral regurgitation cases surgery all in cardiopulmonary bypass, myocardial protection aortic root or direct perfusion of the left, the right coronary artery 4:1 blood cardioplegia, all patients were placed St . Jude Epic bioprosthesis (27-29), all mitral valve surgery structure be retained, 2 mm from the annulus at 12:00 from the front flap incision, extending to both sides to the front and rear flap junction, partial two mitral valve anterior lobe, respectively, the residual leaves and all tendon cable and complete posterior lobe and tendons sewn back, fixed to the front, the posterior lobe of the original annulus. Late postoperative 10d application of echocardiography technical observation of left ventricular diastolic and end-systolic volume index (LVEDVI, LVESVI), ejection fraction (LVEF), peak emptying rate (LVPER), systolic blood flow velocity of the left ventricular outflow tract (LVOT) and residual anterior lobe before forward motion (SAM). Results: There was no operative deaths or serious complications. Aortic average blocking time of 59.88 ± 22.46min. The postoperative LVEDVI, LVESVI significantly lower (all P lt; OO1) the LVEF and LVPER significantly higher than the preoperative (all P lt; 0 05). The preoperative EDVI 71.71 ± 20.62, postoperative 49.06 ± 16.68, the preoperative ESVI43.86 ± 17.79, postoperative 28.71 ± 11.79, preoperative EF40.11 ± 9.93, postoperative 43.56 ± 9.54, ± 0.50 preoperative PER2.91, postoperative 3.45 ± 0.61. Systolic LVOT blood flow velocity without significantly accelerated; no SAM phenomena. Conclusion: Keep mitral before and after the the chordae MVR technology is not easy to promote. Early postoperative left ventricular contraction, pumping function has significant maintenance and improvement. Artificial mechanical valve movement disorders, but there are potential complications of LVOT obstruction.
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