MP66. Technique of Commissural Reconstruction: "Achieving to Type One and Good Diastolic Opening of Mitral Valve in Rheumatic Mitral Repair."
Presented During: Moderated E-Posters
Medanta Superspeciality Hospital
Indore
India - Contact Me
Name: Dr Shipra Shrivastava.
Designation: Associate Director Cardiac Surgery
Work Place: Medanta Hospital, Indore, MP, India
PIN Code: 452010
Years of Experience in Cardia Surgery: More than Twenty Three (23) years
Field of Interese: Entire Spectrum ofAdult Cardiac Surgery with Special focus on Mitral Valve Repairs.
Technicque: My Technique of Commissural Reconstruction in case of Rheumatic Mitral Stenosis has promising results in the immediate post operative findings.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective:
Mitral Valve Repairs and our technique of commissural reconstruction in rheumatic mitral stenosis. Restoring the commissural component of mitral apparatus to its normal function helps in abolishing type two pathology and attaining type one with excellent diastolic opening.
Method:
In our centre in Central India, we witness number of patients with rheumatic heart disease (RHD). Rheumatic valve repairs are always a challenge here, as patients often present late. Also, majority of patients are young females who aspire to complete their family. I started the repair program in 2021 when I was inspired after my AATS- WTS (Women in Thoracic Surgery) international travelling fellowship from the United States in 2017. Rheumatic repairs comprised 52% of all our repairs with a majority, 61.5% being females. Age groups between 20-40 years and 40-60 years were 26.9% and 57.69% respectively. Commissural fusion is an obligatory finding in severe mitral stenosis. So addressing this subset also becomes inevitable to attain better valve dynamics post repair. Besides the standard steps, my technique of commissural reconstruction involved bilateral extended commissurotomy, commissural augmentation with a kite shaped pericardium pretreated with 0.6% glutaraldehyde, creating commissural neo chords and a small patch commissurotomy. The newly constructed commissure supports the leaflets and mitigates the stress in mitral complex. The annulus is always supported with a ring especially CG Future ring in mitral stenosis. This reduced the gradients significantly with trivial or no leak post operatively.
Results:
Commissural reconstruction with our technique resulted in excellent mitral valve area with minimal gradients and trivial or no leak on immediate post operative echocardiography.
Conclusion:
RHD contributes to significant number of acquired heart diseases in India. There is a lack of compliance with anticoagulation therapy. Also, young females who wish to plan family are commonly seen with RHD. We introduced mitral valve repair program in central India. We also focused on the commissural component of the mitral apparatus to achieve a normal leaflet motion which can assist in excellent diastolic opening and seamless systolic closure. A good repair with rheumatic prophylaxis in younger age groups is being considered to achieve good long term result. Our immediate results in rheumatic repairs have been encouraging as yet.
Mitral Valve Repairs and our technique of commissural reconstruction in rheumatic mitral stenosis. Restoring the commissural component of mitral apparatus to its normal function helps in abolishing type two pathology and attaining type one with excellent diastolic opening.
Method:
In our centre in Central India, we witness number of patients with rheumatic heart disease (RHD). Rheumatic valve repairs are always a challenge here, as patients often present late. Also, majority of patients are young females who aspire to complete their family. I started the repair program in 2021 when I was inspired after my AATS- WTS (Women in Thoracic Surgery) international travelling fellowship from the United States in 2017. Rheumatic repairs comprised 52% of all our repairs with a majority, 61.5% being females. Age groups between 20-40 years and 40-60 years were 26.9% and 57.69% respectively. Commissural fusion is an obligatory finding in severe mitral stenosis. So addressing this subset also becomes inevitable to attain better valve dynamics post repair. Besides the standard steps, my technique of commissural reconstruction involved bilateral extended commissurotomy, commissural augmentation with a kite shaped pericardium pretreated with 0.6% glutaraldehyde, creating commissural neo chords and a small patch commissurotomy. The newly constructed commissure supports the leaflets and mitigates the stress in mitral complex. The annulus is always supported with a ring especially CG Future ring in mitral stenosis. This reduced the gradients significantly with trivial or no leak post operatively.
Results:
Commissural reconstruction with our technique resulted in excellent mitral valve area with minimal gradients and trivial or no leak on immediate post operative echocardiography.
Conclusion:
RHD contributes to significant number of acquired heart diseases in India. There is a lack of compliance with anticoagulation therapy. Also, young females who wish to plan family are commonly seen with RHD. We introduced mitral valve repair program in central India. We also focused on the commissural component of the mitral apparatus to achieve a normal leaflet motion which can assist in excellent diastolic opening and seamless systolic closure. A good repair with rheumatic prophylaxis in younger age groups is being considered to achieve good long term result. Our immediate results in rheumatic repairs have been encouraging as yet.