PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF ISCHEMIC MITRAL REGURGITATION COMBINED WITH CORONARY BYPASS GRAFTING

Aim. To assess and analyze the results of surgical treatment carried out in patients with ischemic mitral insufficiency. Materials and methods. The results of surgical treatment of 74 patients with ischemic mitral insufficiency were analyzed. The preoperative assessment of the significance of mitral insufficiency and the causes of its development was carried out using echocardiography, the protocol of which included parameters giving quantitative characteristic of space correlations of the mitral valve structures (fibrous ring diameter, interpapillary distance, annulopapillary distance, cusp tension area, cusp coaptation depth) that permitted to give objective estimation of its function. The results of the preoperative examination indicated presence of the postinfarction remodeling of the left ventricle (LV) cavity, decrease in its contractile function and essential deformation of the mitral valve structures. Results. All patients underwent myocardial revasculization, different variants (reconstruction or replacement) of correction of ischemic mitral insufficiency and surgical remodeling of LV cavity. After the surgery, decrease in LV cavity as well as increase in ejection fraction was registered; after the mitral valve plasty, significant improvement of space-geometric left ventricle to mitral valve ratios at the expense of reduction of cusps-influencing tension forces was revealed. Conclusions. The recovery of normal mitral valve function was the result of geometric reconstruction of LV and valve apparatus.

Ischemic mitral insufficiency, left ventricle remodeling, mitral valve reconstruction