الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
MR is frequent and often silent among patients with IHD. It is strongly associated with heart failure and death among 30-days MI survivors independently of age, gender, and LVEF, which indicates that MR adds prognostic information incremental to known clinical indicators for post-MI risk stratification.
Chronic ischemic mitral regurgitation (cIMR) is becoming the focus of an increasing interest in literatures as it is present in 10- 20% of patients with IHD, caused by LV remodeling. It is referred as functional MR, as opposed to organic MR, because of the normal appearance of the mitral valve leaflets. It is frequently underestimated during intraoperative TEE because of the afterload reduction induced by anaesthetic medications, for this reason the decisions regarding surgical intervention on the MV should be made before patients undergo intraoperative TEE.
RHD continue to be a major health hazard in most developing countries. In Egypt, RHD accounts for 25% of all cardiac surgeries in general, especially for MVD. Rheumatic MR results from either annular dilatation or changes (i.e. fibrosis and/or calcification) in the papillary muscles, chordae tendineae and / or valve leaflets.
There is general agreement that patients with severe MR (grade III/IV) should undergo MV surgery regardless the aetiology. Combined MV and CABG surgery is associated with a higher hospital mortality than that of isolated CABG or isolated MV procedures.
Thus, the current study was undertaken to compare the early results of MV procedure combined with coronary artery bypass grafting in patients with ischemic MVD versus rheumatic MVD
from Jan. 2014 to Dec. 2015, the study was conducted in Cardiac Surgery Unit, Nasser Institute Hospital for research and treatment, on 71 patients with combined IHD and MVD (of ischemic or rheumatic pathology). According to mitral valve pathology, patients were divided into group I: included 35 patients; of rheumatic valve pathology and group II: included 36 patients; of ischemic valve pathology. Both groups compared as regard preoperative, operative and postoperative data.
Preoperative assessment included thorough history taking (registering the sex, age, smoking, diabetes mellitus, hypertension, dyslipidaemia, NYHA grade of dyspnoea and previous intervention), clinical examination, ECG and TTE.
The operative data were registered and included number of conduits, degree of MR, type of the corrective mitral surgery, intraoperative TEE data, duration of the cross clamp, total bypass time and operative morbidity and mortality.
Post-operative parameters were restarted, all events in intensive care unit (ICU) were recorded. The total stay in ICU in hours and the total hospital stay in days were recorded. Follow up were done after 3 & 6 months and all patients were assessed as regard history taking, evaluation of patient’s symptoms, clinical examination, chest X-ray, ECG and Echo examination.
from our study, as regard preoperative data, ischemic valve cases had significantly higher mean age (54.1±5.2 Vs 49.77±6.3) with (P value 0.002) and higher incidence of DM (44 % Vs 17%)with (p value=0.013). male representing the majority of cases 60% in group I &72% in group II. More than half of cases > 64%in both groups were NYHA class III. Rheumatic cases had preoperative higher good LVEF >50 % (88.6 % Vs 36%) while most of the ischemic cases had fair LVEF 35-49% (64% Vs11.4%). There was no significant difference between the two study groups as regard other personal and medical data (hypertension and hypercholesterolemia).
As regard the operative data, the mean number of coronary anastomoses was higher in the ischemic group (2.39±0.96 Vs 1.9±0.83), also the mean cross clamping time (98.6± 33.9 Vs 90.06±30.4 min) and the mean ICU stay (74.58± 54.75 Vs 55.2±32.48 hours) but none of them reach a statistically significant level due to small sample size. Rheumatic MVD cases had significantly higher percentage of failure of repair (valve replacement) (17.1% Vs 0%).Although ischemic group had higher percentage of mortality (13.9% vs 2.9%) it did not reach a statistically significant level (P value=0.199) due to small sample size.
Early 3 and 6 months follow up, both groups showed very good success rate of the surgical repair > 91% and their follow up echo showed no or mild mitral regurgitation.