Circular Plication Annuloplasty for Rheumatic Mitral Valve Disease

Abstract

Fourteen patients with mitral regurgitation and annular dilatation of rheumatic origin underwent surgery at İzmir State Hospital between May 1991 and January 1995. Number 2 polyester suture was attached around the posterior mitral annulus and circular plication was performed by tightening the suture to obtain a competent mitral valve with the largest possible nonstenotic orifice. Preoperatively all the patients had grade 3 or 4 (mean grade 3.41 ± 0.14) mitral regurgitation diagnosed by color Doppler echocardiography. At follow-up (mean follow-up time 35 ± 6.1 months), echocardiography showed 6 patients had grade 1 mitral regurgitation, 6 patients had grade 2, and 2 patients had no regurgitation (mean grade 1.28 ± 0.19). Postoperatively, the mean mitral valve area was found to be 2.74 ± 0.25 cm² by pressure half-time echocardiography. The mean left ventricular diastolic diameter was 63 ± 2.9 mm preoperatively and 52 ± 1.7 mm postoperatively (p < 0.05). The mean gradient across the mitral valve was 5.72 ± 0.78 mm Hg. Success (reduction of mitral regurgitation by at least 2 grades) was 86% at the end of the follow-up period. This annuloplasty technique was found to be a quick and effective method of reducing annular dilatation while maintaining annular flexibility.