Análise comparativa do tamanho e função do ventrículo esquerdo na troca valvar mitral com preservação de cordas na dupla lesão mitral reumática isolada

Objective: to compare clinical outcomes, size and function of the left ventricule of patients with isolated double rheumatic lesions who underwent mitral valve replacement with partial or complete chordal preservation. Methods: This is a cohort study of 100 patients submitted to valve replacement between January 1995 and December 2005. Fifty had the chordal of the posterior and anterior cusps preserved (GAP), and 50 had only the chordal of the posterior leaflets (GP) preserved. The criteria of inclusion were isolated double rheumatic lesion, complete clinical and echocardiographic workup, age between 30-60 years, functional class III-IV (NYHA), elective surgery with normal functioning double leaflet mechanical prosthesis, and no previous cardiac surgery,coronaryopathy or other valvopathy. The primary outcomes for analyses were ecocardiographic parameters of left ventricular function in patients who had a full examination before the surgery and after a follow-up of 48 months. Results: Duration of extracorporeal circulation and ischemia were longer in the GAP group 89.30 + 15.64 X GP 65.72+11.90 (P=<0.001), the size of the device was similar (P=0.188). At the end of the study 72% of the GAP patients were in functional class I X 62% of GP patients (P=0.172). The diastolic diameter of both groups decreased, but more in GAP (P=0.004). The systolic diameter, diastolic volume as well as systolic volume decreased similarly in both groups (P=0.134), (P=0.447) and (P=0.240), respectively. The ejection fraction and the systolic shortening fraction increased in GAP and decreased in GP (P=0.030) and( P=0.008), respectively. Conclusion: The clinical evolution was similar among the patients submitted surgery with chordal preservation with both leaflets or only the posterior. Left ventricular size was decreased more in patients submitted to preservation of boths leaflets (P = 0,004). The left ventricular function was improved more in patients submitted to chordal preservation of the anterior and posterior leaflets (P = 0,030). Descriptors: Mitral valve, surgery. Rheumatic heart disease. Papilary muscles, surgery. Heart valve prosthesis, methods.