[The importance of annulo-ventricular integrity in replacement of the mitral valve. Experience with the double-disc low profile Carbo Medics mechanical valve].

: In the submitted paper the authors compare the results of the conventional replacement of the mitral valve with total excision of the subvalvular apparatus and the results of mitral replacement with a completely or partly preserved or reconstructed integrity of the annulopapillary structures. During the last five years the authors operated by the former method 115 patients (group A) and the second surgical method was used in 93 patients (group B). In both groups the authors compared 33 demographic, clinical, peroperative, postoperative and echocardiographic indicators. Group B comprised substantial more patients with severe myocardial disorders. In the latter group significantly more frequently a mechanical double-disc valve Carbo Medics was implanted than other types of synthetic valves which were used mostly in patients of group A. In patients of group B the operation took longer and after operation they needed more frequently intense inotropic support. Despite that their mortality on hospitalization was lower -3.2% than in group A where it was 6.9%. The late echocardiographic results were also in favour of group B where, contrary to group A, after operation the left ventricular function improved. The authors' experience support the view that preserving the integrity of the annulopapillary apparatus is nowadays one of the demands in surgical correlation of a mitral defect and is of decisive importance for the subsequent fate of the thus treated patients.