Plástica da valva mitral com emprego do anel de Gregori-Braile: análise de 66 pacientes / Mitral valve plastic with use of Gregori-Braile ring: analysis of 66 patients

RESUMO

The complications of valvular prosthesis has led us to preserve the mitral valve. Objective: This paper analyses mitral reconstruction in 66 patients (pts.) where the ring of Gregori-Braile was used, in the period between October 1989 and October 1995. Casuistic and Methods: 45 (74.1 per cent) were male and the mean age was 32.9 years. Rheumatic disease was present in 49 pts. and mitral insufficiency in 38 pts. (57.5 per cent). The follow-up was 2.560 pts./mounth (mean 38.8 months) in 64 pts. (96.9 per cent). The method used to evaluate the patients were as follows clinical symptoms in FC (NYHAC), systolic mitral murmur and Doppler-echocardiographic study in the pre and post-operative period. The mitral techniques were ring implantation, mobilization of leaflets and chordae tendinae and restriction of valve mobility. Shortening of the chordae was used in 44 pts. (66.6 per cent). Associated procedures were reduction of the LA (8 pts.), aortic valve replacement (3 pts.) and Cox procedure in 3 pts. One patient died (1.5 per cent) in early PO from pulmonar thromboembolism. Results: The PO functional class improved. In the pre-op 41 pts. (62.1 per cent) were in FC III and 23 pts. in FCIV (34.8 per cent). In the PO, 53 pts (80.3 per cent) were in FC I and 8 pts. (12.1 per cent) in FC II. The mitral murmur was absent or + intensity in 92.4 per cent in PO. The FC and murmur improved significantly (p < 0.001). The Doppler-echocardiographic study showed mean left ventricular diastolic diameter was 5.96 cm in the pre-op and 5.33 cm in the PO (p < 0.001); mean LA dimension was 5.67 cm (pre-op) and 4.65 cm in the PO (p < 0.001); mean aortic diameter was 2.97 cm in the pre-op and 3.13 cm in PO (p < 0.01); the mean shortening was 35.38 per cent in pre-op and 34.12 per cent in PO (not significantly). The mean valve area was 1.7 cm2 in the pre-op period and 2.43 cm2 in PO (p < 0.003) and the mean gradient pressure in the pre-op and PO period was 11.10 mmHg and 5.58 mmHg (p < 0.003), respectively. In the late PO, 3 pts. died (4.5 per cent). After 72 months, the survival was 95.5 per cent, 96 per cent free from reoperation and 98.4 per cent free from thromboembolism. Conclusions: Mitral reconstruction is a safe procedure, the improvement in functional class was statistically significant, and the procedure should be done whenever possible to correct the mixed lesion and mitral insufficiency.