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Abstract
RECOMMENDATIONS n developing countries, rheumatic fever, a sequel of group A streptococcal upper respiratory tract infection, is responsible for almost half of cardiovascular disease in all age groups, and is leading cause of death in the 1st five decades of life. Mitral valve disease is the most common rheumatic valve disease.
Mitral valve repair is the procedure of choice to treat mitral valve dysfunction of all etiologies. Advantages of mitral valve repair over mitral valve replacement include improved long-term survival, better preservation of left ventricular function, and greater freedom from endocarditis, thromboembolism, and anticoagulant-related hemorrhage. With the introduction of standardized surgical techniques by Carpentier, Duran, and others, mitral valve repair has become reproducible and widely disseminated.
When mitral valve repair is not feasible, mitral valve replacement will be the only choice. The bileaflet model is almost with streamline flow, this feature emerged it as today’s prosthesis of preference in many centers, despite its higher coast. We tried in this study to not only to get the best prosthetic valve design but also to get the best orientation of this valve to obtain its best performance.
We selected a hundred patients who needed mitral valve replacement and evaluated them clinically and echocardiographically preoperatively. The patients underwent mitral valve replacement where 50 patients of them received the bileaflet metallic mitral valve (St. Jude, 29 mm) in anatomical orientation while the other 50 patients received the same valve in antianatomical orientation with posterior leaflet preservation for all cases.