Patient With Heart Failure And Mitral Insufficiency Submitted Mitral Valve Replacement And Crossed Papillopexy Video-assisted

Ricardo Adala Benfatti1 , Amanda Carli Benfatti2 , Marco Antônio Araújo Mello1 , José Anderson Goldiano1 , Firmino Teodoro Silva Filho1, Geisa Cavalcante Souza1

 1Federal University of Mato Grosso Do Sul; 2 Instituto De Cardiologia Campo Grande, Campo Grande, Brazil

BACKGROUND: : The cardiac failure is a serious public health problem and it’s one of the principal causes of mortality and morbidity. The standard surgical treatment is the cardiac transplant, but because of the treatment’s difficulties, another surgical proposal are being reported on literature, among them the mitral insufficiency surgery.

Goal: To show and verify the influence of the crossed papillopexy and implant of valve prosthesis with annular constriction trans areolar minimally invasive video-assisted in patient with important insufficiency in the functional class, and echocardiographic data 90 days post-operative.

METHODS: Case report of a patient, female, 61 years old, with advanced cardiac insufficiency in functional class IV (NYHA), severe mitral valve insufficiency, submitted to the mechanical mitral valve replacement, number 29, trans areolar access, with annular constriction, and preservation of the sub valve apparatus, crossing the front cusp (crossed papillopexy). Time of surgery 240 minutes, extracorporeal time of 150 minutes, and aortic clamp 120 minutes. The functional class (NYHA), the echocardiographic data from were evaluated in the preoperative and 3 months post-operatively.

RESULTS: The patient demonstrate evidence of significant clinical and echocardiographic improvement. All the echocardiographic data had significant improvement, left ventricular diastolic diameter reduced from 69 mm to 53 mm, left ventricular systolic diameter reduced from 59 mm to 38 mm, the left atrial diameter varied from 56 mm to 47 mm, and ejection fraction there was a significant increment of 29% to 54%. For the clinical evaluation in 90 days after the surgery, the patient was in functional class I.

CONCLUSIONS:  The crossed papillopexy and the mitral valve replacement with annular constriction trans areolar minimally invasive video-assisted surgery in patients with advanced heart failure carriers' important mitral insufficiency improvement of the functional class, and of the echocardiographic data.