Results of conservative or substitutive surgical treatment in mitral valve prolapse caused by redundant cusps

: Between October 1969 and October 1979 120 patients (78 males and 42 females, mean age 48 years) underwent surgical correction of floppy mitral valve at Harefield Hospital. Family history of mitral valve disease was present in 3 patients and 6 had skeletal manifestations of Marfan syndrome. The presenting symptom was shortness of breath in 110 (92%), chest pain in 18 (15%), and palpitations in 29 (24%). Thirty-two patients had more than one symptom. A history of bacterial endocarditis was obtained from 18 patients. At the time of operation 88% of the patients were in class III-IV NYHA. Forty-five patients had mitral valve replacement and the remaining 75 had a conservative procedure. Findings at operation were: rupture of posterior chordae in 72 (60%); rupture of anterior chordae in 15 (13%); rupture of anterior and posterior chordae in 6 and elongation of chordae without rupture in 27 (22%). Hospital mortality for isolated replacement was 6.5%. Twenty-seven patients (22%) died subsequently (mean follow-up of 75 months). Hospital mortality for repair was 3.2% and late mortality mean follow-up 34 months) was 6.5%. Sixty-seven patients are asymptomatic and 21 are improved. A conservative approach to floppy mitral valve disease has been adopted in all patients since 1974 and has given better early and late results compared to valve replacement.