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Biomedical subjects

M Nagatsu

Publications and source records attributed to M Nagatsu.

At least 37 records · Page 2Linked to original sources

Role of microtubules in contractile dysfunction of hypertrophied cardiocytes.

Cardiac hypertrophy in response to systolic pressure overloading frequently results in contractile dysfunction, the cause for which has been unknown. Since, in contrast, the same degree and duration of hypertrophy in response to systolic volume overloading does not result in contractile dysfunction, we postulated that the contractile dysfunction of pressure hypertrophied myocardium might result from a direct effect of stress as opposed to strain loading on an intracellular structure of the hypertrophied cardiocyte. The specific hypothesis tested here is that the microtubule component of the cytoskeleton is such an intracellular structure, which, forming in excess, impedes sarcomere motion. The feline right ventricle was either pressure overloaded by pulmonary artery banding or volume overloaded by atrial septotomy. The quantity of microtubules was estimated from immunoblots and immunofluorescent micrographs, and their mechanical effects were assessed by measuring sarcomere motion during microtubule depolymerization. We show here that stress loading increases the microtubule component of the cardiac muscle cell cytoskeleton; this apparently is responsible for the entirety of the cellular contractile dysfunction seen in our model of pressure-hypertrophied myocardium. No such effects were seen in right ventricular cardiocytes from normal or volume-overloaded cats or in left ventricular cardiocytes from any group of cats. Importantly, the linked microtubule and contractile abnormalities are persistent and thus may be found to have significance for the deterioration of initially compensatory cardiac hypertrophy into the congestive heart failure state.

Animals↗

Acute changes in myosin heavy chain synthesis rate in pressure versus volume overload.

The left ventricular hypertrophy that develops with the volume overload of mitral regurgitation is relatively less than that which develops with the pressure overload of aortic stenosis even when both lesions are severe. The hypertrophy that develops must be the sum of changes in the rate of myocardial protein synthesis and degradation. In the present canine study, we explored early changes in the synthesis rate of myosin heavy chain in response to severe acute pressure overload versus that of the severe acute volume overload of mitral regurgitation. We tested the hypothesis that in acute overload, the rate of protein synthesis would increase less in the volume-overload model than in the pressure-overload model, a potential partial mechanism for the discrepancy in the eventual total amount of hypertrophy that develops in these two lesions. Acute pressure overload was produced by inflating a balloon in the descending aorta, and acute volume overload was produced by using our closed-chest mitral chordal rupture technique. In both models, the hemodynamic lesion that was created was severe. In eight dogs with pressure overload, the average gradient across the balloon was 119.8 +/- 6.1 mm Hg. In six dogs with volume overload, the average regurgitant fraction was 0.67 +/- 0.06. Six other dogs served as controls. The average rate of myosin heavy chain synthesis in control dogs was 2.7 +/- 0.2% per day, virtually identical to the rate we found in the severe volume-overload model. In contrast, the rate was increased in the pressure-overload model by 30% to 3.5 +/- 0.3% per day (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

Effects of chronic beta-adrenergic blockade on the left ventricular and cardiocyte abnormalities of chronic canine mitral regurgitation.

The mechanism by which beta blockade improves left ventricular dysfunction in various cardiomyopathies has been ascribed to improved contractile function of the myocardium or to improved beta-adrenergic responsiveness. In this study we tested two hypotheses: (a) that chronic beta blockade would improve the left ventricular dysfunction which develops in mitral regurgitation, and (b) that an important mechanism of this effect would be improved innate contractile function of the myocardium. Two groups of six dogs with chronic severe mitral regurgitation were studied. After 3 mo both groups had developed similar and significant left ventricular dysfunction. One group was then gradually beta-blocked while the second group continued to be observed without further intervention. In the group that remained unblocked, contractile function remained depressed. However, in the group that received chronic beta blockade, contractile function improved substantially. The contractility of cardiocytes isolated from the unblocked hearts and then studied in the absence of beta receptor stimulation was extremely depressed. However, contractility of cardiocytes isolated from the beta-blocked ventricles was virtually normal. Consistent with these data, myofibrillar density was much higher, 55 +/- 4% in the beta-blocked group vs. 39 +/- 2% (P < 0.01) in the unblocked group; thus, there were more contractile elements to generate force in the beta-blocked group. We conclude that chronic beta blockade improves left ventricular function in chronic experimental mitral regurgitation. This improvement was associated with an improvement in the innate contractile function of isolated cardiocytes, which in turn is associated with an increase in the number of contractile elements.

Adrenergic beta-Antagonists↗

The effects of complete versus incomplete mitral valve repair in experimental mitral regurgitation.

Severe mitral regurgitation (regurgitant fraction 0.75 +/- 0.02) was created in eight dogs by our closed-chest chordal rupture technique. After 3 months of chronic mitral regurgitation all indices of contractile function were depressed. Mitral valve repair was then attempted. Postoperative regurgitant fraction was reduced compared with the preoperative value in all eight dogs. Concomitantly, forward cardiac output increased in all dogs and pulmonary capillary wedge pressure fell in all dogs. However, in some dogs, significant regurgitation persisted despite repair. Postoperative regurgitant fraction ranged from 0% to 60%. Postoperative residual regurgitant fraction was related significantly to postoperative cardiac output (r = 0.99), pulmonary capillary wedge pressure (r = 0.77), ejection fraction (r = 0.75), and two indices of contractile function--the mass-corrected end-systolic stress volume relationship (r = 0.87) and end-systolic stiffness (r = 0.93). In general, these parameters returned to their normal values before mitral regurgitation when postoperative regurgitant fraction was less than 30%. Myocytes isolated from the ventricles at the end of study also demonstrated normal contractile function when regurgitant fraction was less than 30%.

Animals↗

[Anomalous origin of the right pulmonary artery from the ascending aorta: a report of eight cases].

We report eight cases with anomalous origin of the right pulmonary artery from ascending aorta. The ages at operation ranged from five days to fifteen years (average two years and seven months) with the body weights ranging from 1,610 g to 47.5 kg. Two patients underwent a surgical intervention in infancy; one of them with the body weight of 1,610 g was the smallest case previously reported in Japan. Associated cardiothoracic anomalies were patent ductus arteriosus (PDA) in five patients, atrial septal defect (ASD), PDA with ASD, tetralogy of Fallot with absent pulmonary valve in each one patient. Preoperative systolic pressure of pulmonary trunk were varied 83 to 115 mmHg (mean 94.7 mmHg). The continuity between pulmonary trunk and detached right central pulmonary artery was restored by a direct side-to-end anastomosis either behind (anatomical route) or in front of (non-anatomical route) the ascending aorta in all but one patient. There were one operative death and one hospital death. Postoperative pulmonary pressure was lower in patients with anatomical route than in patients with non-anatomical route. We conclude that successful surgical repair can be achieved by a direct anastomosis between abnormal detached central pulmonary artery and pulmonary trunk behind the ascending aorta even in infancy or early in childhood.

Adolescent↗

[Biventricular repair with a modified Glenn shunt for the hypoplastic right ventricle].

Between 1982 and 1990, 14 patients with small right ventricle underwent biventricular repair with a modified Glenn shunt. The patients consisted of 8 cases of pulmonary atresia and intact ventricular septum, 2 with pulmonary stenosis and intact ventricular septum, 3 with tetralogy of Fallot, 1 with pulmonary atresia and straddling tricuspid valve. Nine patients had one or more prior preliminary palliative procedures. Repairs consisted of a modified Glenn shunt and closure of the intracardiac and extracardiac shunt, with right ventricular outflow reconstruction in 13, and pulmonary valvotomy in 1. In nine patients superior vena cava was not ligated. There was one operative death (7%). Preoperative RVEDV ranged from 19 to 70% of normal with a mean of 36.1% of normal. Preoperative pulmonary resistance ranged from 1.6 to 5.3 unit with a mean of 2.8 unit. Preoperative PA index ranged from 102 to 444 mm2/m2 with a mean of 234.3 mm2/m2. No patients died later. Follow-up 2 to 9 year after operation showed that 9 patients were in the New York Heart Association class I and 4 were in class II. Our experience shows that this procedure can be safely done for patients, who have hypoplastic right ventricle smaller than 40% of normal and are not candidate for Fontan procedure because of high pulmonary vascular resistance and inadequate size of pulmonary artery. In this procedure a modified Glenn shunt without ligation of SVC may effectively reduce the volume overload on the right ventricle.

Adolescent↗

[Surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis].

Between 1986 and 1990, fourteen patients with univentricular atrioventricular connection and subaortic stenosis underwent surgical treatment. The patients consisted of 7 cases of double inlet left ventricle, 4 with double inlet right ventricle, 3 with tricuspid atresia. The palliative operation was performed in 6 infants ranging in age from 17 days to 6 months. Four patients with mild subaortic stenosis underwent pulmonary artery banding, in two patients this was combined with repair of coarctation of the aorta. Two patients with severe subaortic stenosis underwent the Norwood operation. There were no operative deaths. One of two patients who underwent the Fontan operation 2 years after the Norwood operation died later. The definitive operation was performed in 8 children ranging in age from 4 to 11 years. Five of these 8 patients had previous pulmonary artery banding. Five children with double inlet left ventricle underwent septation combined with enlargement of bulboventricular foramen. Postoperatively all remained in sinus rhythm and had no pressure gradient between Aorta and left ventricle. A Fontan operation combined with a Damus operation was performed in 2 children, 1 of double inlet right ventricle and 1 of tricuspid atresia. In both cases, postoperative angiogram showed no pulmonary incompetence. One patient underwent enlargement of bulboventricular foramen after a Fontan operation. All survived later. Young infants and neonates with severe subaortic stenosis can survive by the Norwood operation. Infants with mild subaortic stenosis, although can survive by pulmonary artery banding, should be closely followed for the development of subaortic stenosis. For relief of subaortic stenosis, enlargement of bulboventricular foramen may be effective in septation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Coarctation↗

Anatomic correction of atrioventricular discordance.

Between June 1989 and September 1991, 11 patients underwent anatomic correction of atrioventricular discordance. Their ages at operation ranged from 1 to 11 years (mean 6.7 years) and their weights ranged from 7.1 to 31.8 kg (mean 19.1 kg). Atrial situs was solitus in nine and inversus in two patients. Ventriculoarterial connection was discordant in five and was double-outlet right ventricle in six patients. Associated congenital heart defects were seen in all patients, including 10 with ventricular septal defect, eight with atrial septal defect, nine with pulmonary stenosis or pulmonary atresia, seven with tricuspid regurgitation, and four with mitral regurgitation. Five patients had prior Blalock-Taussig shunts. One patient with an intact ventricular septum had repeated pulmonary banding. Anatomic correction consisted of the Senning and Rastelli procedures in three, the Mustard and Rastelli procedures in five, the Senning and arterial switch operations in two, and the Mustard and arterial switch operations in one patient. In addition, mitral valvuloplasty or valvular annuloplasty was performed in three patients. We did not encounter kinking or torsion of the translocated coronary arteries in our three patients with the arterial switch operation. There was one surgical death. The other patients pursued satisfactory postoperative courses (mean follow-up period of 12.6 months). We recommend that anatomic correction for atrioventricular discordance should be indicated, especially in patients with any sign of systemic right ventricular dysfunction.

Cardiac Surgical Procedures↗

[Definitive repair for double inlet ventricle and common atrio-ventricular valve].

From 1982 through 1990, 13 patients with double inlet ventricle and common atrio-ventricular valve underwent definitive cardiac surgery. Nine patients simultaneously had anomalous systemic venous connection and 4 had anomalous pulmonary venous connection. One patient with double inlet left ventricle underwent a successful partition of ventricle and atrio-ventricular valve. All other 12 patients underwent a Fontan operation, which utilized different techniques to deal with various forms of anomalous systemic and pulmonary venous connection. Four patients with common atrioventricular valve regurgitation underwent a Fontan operation combined with a concomitant circular annuloplasty of atrio-ventricular valve. In all 4 patients, the degree of regurgitation decreased postoperatively. There was one operative death (mortality 7.7%). Most of patients with double inlet ventricle and common atrio-ventricular valve now are considered to be suitable not for partition but for the Fontan operation. Because of the complexity of anatomic variables, however, the repair of anomalous systemic or pulmonary venous connections in conjunction with the Fontan operation requires an individualised plan in each patient to provide unobstructed systemic and pulmonary venous pathways. We think that a circular annuloplasty could effectively decrease the degree of atrio-ventricular valve regurgitation in most cases.

Adolescent↗

Coronary blood flow after the regression of pressure-overload left ventricular hypertrophy.

Abnormal coronary blood flow (CBF) in long-standing left ventricular (LV) pressure-overload hypertrophy has been associated with ischemia and LV dysfunction. Thus, goals of therapy in pressure overload are not only the relief of the overload itself but also regression in hypertrophy and subsequent improvement in CBF. However, little is known about CBF in humans or in large mammals after the relief of pressure overload, when the hypertrophy has regressed. This study was performed to test the hypothesis that, even 6 months after the relief of pressure overload in the dog, CBF would still be abnormal. Three groups of dogs were studied: 1) normal control dogs (NL group), 2) dogs with LV pressure-overload hypertrophy (LVH group), and 3) dogs that had developed LV pressure-overload hypertrophy but in whom the pressure overload was relieved 6 months before the final study (LVH Reg group). CBF was studied in conscious dogs by use of the radiolabeled microsphere technique at rest, during rapid atrial pacing, and during maximum coronary vasodilation produced by adenosine infusion. The ratio of LV weight (g) to body weight (kg) (LVBW) was 4.2 +/- 0.3 in the NL group, 7.1 +/- 0.6 in the LVH group, and 7.7 +/- 0.5 in the LVH Reg group before pressure-overload relief (p = NS, LVH versus LVH Reg). Six months after removal of the pressure overload, the LVBW in the LVH Reg group had fallen to 5.5 +/- 0.3 (p < 0.05), but this LVBW was still greater than that in the NL group (p < 0.05). During rapid atrial pacing, endocardial and epicardial CBF rose significantly in NL dogs. However, during rapid atrial pacing, endocardial CBF fell from 1.18 +/- 0.22 to 0.7 +/- 0.20 ml/min per gram in the LVH group (p < 0.05) and did not rise in the LVH Reg group. During adenosine infusion, endocardial blood flow increased in NL dogs from 1.63 +/- 0.13 to 4.0 +/- 0.3 ml/min per gram and increased to a similar level in the LVH Reg group. Although CBF increased during adenosine infusion in the LVH group, the increase was less than that in the NL or LVH Reg group (p < 0.05). Minimum coronary vascular resistance was similar in NL dogs (14 +/- 2 units) and LVH Reg dogs (18 +/- 3 units, p = NS) but was significantly elevated (32 +/- 10 units) in LVH dogs (p < 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)

Adenosine↗

[Surgical correction of atrioventricular discordance--results and follow-up].

Between January 1977 and October 1991, 47 consecutive patients with atrioventricular discordance, ventriculoarterial discordance, and two ventricles underwent intracardiac repair at the Heart Institute of Japan. Their ages at operation ranged from 2 months to 21 years (average 9.2 years) and period of follow-up ranged from 1 month to 168 months (average 65.1 months). There were five basic anatomic types according to the associated anomalies, grouped into (1) situs solitus, ventriculoarterial (V-A) discordance or double-outlet right ventricle (DORV), ventricular septal defect (VSD) and pulmonary outflow tract obstruction (POTO) (31 patients); (2) situs solitus, V-A discordance and VSD (6 patients); (3) situs solitus, V-A discordance and tricuspid regurgitation (TR) (2 patients); (4) situs inversus, V-A discordance or DORV, VSA and POTO (7 patients); (5) situs inversus, V-A discordance and VSD (1 patient). TR was evident preoperatively in 13 patients (28% of 47 patients), one of whom had Ebstein's anomaly. The conventional operation, which consisted of closure of VSD (34 patients), posterolateral pulmonary outflow enlargement (2 patients), tricuspid valvuloplasty (2 patients), and tricuspid replacement (1 patient) using the anatomical right ventricle as the systemic ventricle, was performed in 35 patients (RV group). The anatomic correction (so-called "double switch operation"), the new alternative operation using the anatomical left ventricle as the systemic ventricle, was achieved in 12 patients (LV group). Anatomic correction consisted of Senning and RV-PA ECR in 3, Mustard and RV-PA ECR in 4, Senning and arterial switch in 2, and Mustard and arterial switch in 1 patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Assessment of long-term systemic ventricular function after the surgical repair in patients with atrioventricular discordance].

Long-term systemic ventricular function at rest and during supine bicycle exercise was studied in 12 patients with atrioventricular discordance (AVD group) using multigated radionuclide blood pool imaging. For comparison, similar measurements were made in eight children (control group). The mean age at the exercise test was 12.3 years in AVD group and was 14.8 years in the control group. In AVD group, ages at the operation ranged from three to 21 years (mean 12.3 years), and the exercise test was performed from one to 9.8 years after the operation (mean 5.3 years). The operative procedures in AVD group consisted of closure of the ventricular septal defect in 11 patients, extracardiac conduit between the left ventricle and the pulmonary artery in nine patients, postero-lateral left ventricular outflow reconstruction in two patients, tricuspid annuloplasty in one patient, and tricuspid valve replacement in one patient. Exercise tolerance of AVD group was less than that of the control group. Heart rate and blood pressure were significantly increased during exercise in both groups. In the control group, end-diastolic count index (EDCI) (= end-diastolic volume) remained unchanged and end-systolic count index (ESCI) (= end-systolic volume) decreased during exercise. In contrast, both EDCI and ESCI were decreased in AVD group. As a consequence, systemic right ventricular ejection fraction (RVEF) increased during exercise in the control group, but remained unchanged in AVD group. Although stroke count index (SCI) (= stroke volume index) did not increased during exercise in AVD group, output count index (OCI) (= cardiac index) increased with the increase of heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Clinical classification and surgical treatment of cor triatriatum].

Twenty-one patients (age 35 days to 39 years) with cor triatriatum were treated surgically over a 17 year period at our institute. We define cor triatriatum as a congenital heart anomaly with the presence of an abnormal diaphragm that subdivides the left atrium into an accessory and a true left atrial chambers and that has "direct" hemodynamic communication between an accessory and a true left atrial chambers through one or more fenestration irrespective of accompaniment of an atrial septal defect or a partial anomalous pulmonary venous connection. By contrast with our findings of the hearts with cor triatriatum, every representative classification, such as Lucas-Schmidt's one, had some lack or duplication of the addressed types respectively. So we presented a clinical classification of cor triatriatum as follows: type I is the classical form with intact atrial septum, type IIa has an ASD between an accessory and a right atrial chambers, type IIb has an ASD between a right and a true left atrial chambers, and type IIc is a complexed form that has both communications of IIa's and IIb's. Of 14 typical cor triatriatum without isomerism nor other major complexed anomalies, 7 cases belonged to type I, and IIa 4, IIb 2, IIc 1 respectively. Of 7 so-called atypical cases, 5 cases belonged to type IIc and the rest two were unclassified complexed forms. Characteristically all of atypical cases had persistent left superior vena cava in common. 17 patients underwent total corrections and the rest 4 cases with single right ventricles underwent palliative operations for Fontan procedure in the near future. Transaccessory chamber approach for type I and IIb as the first choice provided ample exposure for complete excision of the obstructing membrane. Trans-right atrial approach were employed for closure of ASDs or for the other intraatrial partitions. Incision of the atrial septum should be avoided to prevent postoperative supraventricular arrhythmias if possible. There were no surgical death nor late death over 6 years follow-up period on the average. There existed some atypical cases that seemed very difficult to make differential diagnoses preoperatively, so careful surgical investigations into intraatrial anatomy should be made to perform proper corrections especially in the atypical cases.

Adult↗

[Method to make the tricuspid extracardiac conduit by heterogeneous pericardium].

We described here, how to make tricuspid extracardiac conduit by heterogeneous pericardium for Rastelli procedure. We have developed some ingenious devices which allow to obtain good hemodynamics. One of the devices is large valvular leaflets as long as 130% of the circumference of the conduit. Another device is the commissural suture as figure of eight. We used 121 tricuspid extracardiac conduits between January 1985 and March 1991. There were two reoperations: One from stenosis at the suture with ventricle and the other from infective endocarditis. This hand-made conduit has the advantages of flexibility, fitness with the pulmonary artery, wide range of size and very little regurgitation. These advantages indicate that the tricuspid extracardiac conduit made by heterogeneous pericardium is a valved conduit substitute of choice for Rastelli procedure. The durability of the conduit is to be further evaluated.

Animals↗

[Conotruncal repair of tetralogy of Fallot under 2 years old].

From October 1985 to September 1990, a repair within the conotruncal portion of the right ventricle-Conotruncal repair-was used for the primary repair of consecutive 34 patients with tetralogy of Fallot under the age of 2 years. There were three summarized points of this maneuver: the first was non-use of the tricuspid septal leaflet for closure of the ventricular septal defect, the second was short patch infundibuloplasty with a large monocusp, and the last was total resection of the infundibular septum. Length of the patch infundibuloplasty was just 30% of the right ventricle length according to our formula: 30% of RV (cm) = 1.28 X BSA (m2) + 1.10. The VSD patch was placed between the pulmonary annulus and the ventricular septal crest, consisting of the membranous flap and the posterior extension of the trabecula septomarginalis. The right ventricular (RV) to systemic arterial pressure ratio was 0.49 +/- 0.15 (N = 33) and central venous pressure was 10.2 +/- 1.9 cmH2O (N = 33) six hours after ICU admission and 8.4 +/- 1.5 cmH2O (N = 7) 18 days after operation. RV end-diastolic volume showed no increase after operation: 105 +/- 31 before repair to 104 +/- 23% of Normal after repair in the same patients. Post-operative intubation period was 14 +/- 8 hours and hospital admission period was 17 +/- 6 days after operation. All patients were in sinus rhythm. The 28% of patients showed incomplete right bundle branch block (RBBB) and other 28% of patients showed complete RBBB.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗

Pulmonary flow-resistance relationships in allografts after single lung transplantation in dogs.

To evaluate the applicability of single lung transplantation as a treatment of pulmonary hypertension, we investigated the relationships between the pulmonary blood flow and resistance in allografts 10 days after single lung transplantation in dogs. In eight surviving recipients and five healthy dogs (control group), pulmonary flow-resistance relationships were investigated at flows in the range of 0.3 to 2.0 L/min at 0.1 L/min increments. Resistance decreased from 2585 to 746 dyne.sec.cm-5 in the successful group (five allografts receiving complete studies) and 2400 to 891 in the control group with an increase of flow. Lung water content of the successful group was 2.0 times that of the control group (successful group, 95.6 +/- 16.7 gm; control group, 47.8 +/- 7.5 gm), and water content of the other allografts (unsuccessful group), including allografts of dogs that died before investigations, was 2.2 times that of the successful group (unsuccessful group, 211.0 +/- 89.6 gm). The chest roentgenograms of the successful group showed mild or moderate consolidations, whereas those of the unsuccessful group showed severe consolidations, but no difference was found in pulmonary flow-resistance relationships between the successful and the control groups. These results show that the allografts, which have about twice the water content of normal lung, maintain adequate pulmonary vascular function. We concluded that single lung transplantation could be an effective treatment for pulmonary hypertension.

Animals↗

[Mitral insufficiency due to ruptured chordae tendineae--clinical features, early and late results of valve replacement and repair].

To evaluate the early and late results of mitral valve replacement and reconstruction for mitral insufficiency due to ruptured chordae tendineae respectively, 74 consecutive cases were analyzed. Fifty-five (74.3%) of the patients were men, and the mean age was 48 +/- 12 years old (range 16 to 76). The causes of the mitral disease were idiopathic in 50 (67.6%), rheumatic in 7 (9.4%) and infective endocarditis in 11 (14.9%) patients. In idiopathic 50 cases, 24 had mitral valve prolapse and 16 had both mitral valve prolapse and hypertension. Forty-one (55.4%) of the patients were in NYHA functional class III or IV preoperatively. Thirty (40.5%) cases underwent surgery within one year after their initial symptoms of heart failure onsets including six emergency operation cases due to uncontrollable acute lung edema. Chordae to anterior mitral leaflet were ruptured in 31 (a5, m16, p10)[41%] patients, to the posterior mitral leaflet in 45 (a4, m23, p18)[59%], and to both leaflets in one patient. Mitral valve replacement was performed in 68 patients (91.9%) and 6 patients (8.1%) underwent mitral valve repairs. Twenty cases underwent associated procedures that included tricuspid valve annuloplasty in 8, aortic valve replacement in 5 and myocardial revascularization in 4 cases. There were two operative deaths (2.4%); both occurred after replacement, left ventricular rupture in one and DIC in one. Mean follow-up period was 4.5 years (range 1 to 17) in 67 cases. There were four late deaths; all occurred after replacement. However five patients sustained mild mitral insufficiency after mitral valve repair including one that became worse of regurgitation three years after isolated Kay's annuloplasty, there were no cases that had needed reoperation and no late death after reconstruction. Left ventricular function and pulmonary arterial pressure were almost normalized in more than 90% cases postoperatively. Our data indicated that mitral valve reconstruction (McGoon's plus Kay's method as standardized maneuver) was the procedure of choice for selected patients with mitral insufficiency owing to ruptured chordae tendineae to the posterior mitral leaflet, including more limited patients with ruptured chordae to the anterior mitral leaflet.

Adolescent↗