Plástica da valva mitral com emprego do anel de Gregori-Braile: análise de 66 pacientes

the complications of valvular prosthesis has led us to preserve the mitral valve. objective: this paper analyses mitral reconstruction in 66 patients (pts.) where the ring of gregori-braile was used, in the period between october 1989 and october 1995. casuistic and methods: 45 (74.1%) were male and the mean age was 32.9 years. rheumatic disease was present in 49 pts. and mitral insufficiency in 38 pts. (57.5%). the follow-up was 2.560 pts./mounth (mean 38.8 months) in 64 pts. (96.9%). the method used to evaluate the patients were as follows: clinical symptoms in fc (nyhac), systolic mitral murmur and doppler-echocardiographic study in the pre and post-operative period. the mitral techniques were: ring implantation, mobilization of leaflets and chordae tendinae and restriction of valve mobility. shortening of the chordae was used in 44 pts. (66.6%). associated procedures were: reduction of the la (8 pts.), aortic valve replacement (3 pts.) and cox procedure in 3 pts. one patient died (1.5%) in early po from pulmonar thromboembolism. results: the po functional class improved. in the pre-op 41 pts. (62.1%) were in fc iii and 23 pts. in fciv (34.8%). in the po, 53 pts (80.3%) were in fc i and 8 pts. (12.1%) in fc ii. the mitral murmur was absent or + intensity in 92.4% in po. the fc and murmur improved significantly (p < 0.001). the doppler-echocardiographic study showed: mean left ventricular diastolic diameter was 5.96 cm in the pre-op and 5.33 cm in the po (p < 0.001); mean la dimension was 5.67 cm (pre-op) and 4.65 cm in the po (p < 0.001); mean aortic diameter was 2.97 cm in the pre-op and 3.13 cm in po (p < 0.01); the mean shortening was 35.38% in pre-op and 34.12% in po (not significantly). the mean valve area was 1.7 cm2 in the pre-op period and 2.43 cm2 in po (p < 0.003) and the mean gradient pressure in the pre-op and po period was 11.10 mmhg and 5.58 mmhg (p < 0.003), respectively. in the late po, 3 pts. died (4.5%). after 72 months, the survival was 95.5%,