Hemodynamic and cineangiographic study before and after mitral valvuloplasty (Carpentier's technique)

Hemodynamic studies were performed in 26 patients 2-60 months after mitral valvuloplasty (average 14 months). All patients but one had an annular deformity requiring prosthetic ring annuloplasty. In addition, 25 patients had prolapsed leaflet or restricted leaflet motion requiring specific techniques of repair. All patients were asymptomatic after operation. Significant residual mitral insufficiency was present in only five patients. Roentgenograms showed a reduction in cardiothoracic ratio, from 0.62 +/- 0.07 preoperatively to 0.53 +/- 0.06 postoperatively (p less than 0.001). Mean pulmonary artery pressure decreased from 30 +/- 12 mm Hg to 18 +/- 6 mm Hg (p less than 0.001) and cardiac index returned to normal (2.7 +/- 0.7 1/min/m2 vs 3.1 +/- 0.7 1/min/m2, p less than 0.02). Angiocardiographic studies showed that end-diastolic volume index returned to normal (148 +/- 41 cm3/m2 vs 89 +/- 23 cm3/m2, p less than 0.001), with significant decreases in end-systolic volume index ( 63 +/- 27 cm3/m2 vs 43 +/- 16 cm3/m2, p less than 0.001), left ventricular mass (114 +/- 28 g/m2 vs 88 +/- 20 g/m2, p less than 0.001), ejection fraction (58 +/- 11% vs 52 +/- 11%, p less than 0.02) and mean velocity of fiber shortening (1.19 +/- 0.36 circ/sec vs 1.01 +/- 0.24 circ/sec, p less than 0.05). We conclude that mitral valvuloplasty provides good and stable midterm results and that the operation should be performed before irreversible myocardial lesions occur.