Hasan Maghur1 , Jumma Madi2, Salah Abuzaghar1, Mohammed Saleem2
1-Department of Surgery; 2-Department of Medicine, Faculty of Medicine, Elfateh University, Tripoli, Libya
JMJ Vol. 5, No 2 (Summer) 2006: 129-132
Method: Over a period of 10 years (1992-2002), a total of 261 patients (145 females, 116 males; age range 10-70y; mean 32y) with mitral valve disease underwent 275 operations on their mitral valves. Mitral valve replacement (MVR) was performed on 172(63%) patients, open mitral valvotomy (OMV) on 76(28%) patients, closed mitral valvotomy (CMV) on 20(7.2%) patients and mitral valve repair (MVRp) on 7(2.5%) patients. Mitral stenosis (MS) was the predominant lesion in 162(59%) patients with 66(41%) patients requiring valve replacement, whereas mitral regurgitation (MR) was predominant in 113 (41%) patients, out of which 106(94%) patients required valve replacement. Redo surgery was performed on 32 (12%) patients. Concomitant operations were performed on 46(17%) patients, mainly aortic valve replacement (30 patients). Left atrial (LA) thrombus was present in 19(11.7%) patients out of 162 patients with mitral stenosis. Results: Overall early mortality (EM) occurred in 13(6%) patients. Closed mitral valvotomy carried a 0% EM but high (35%) reoperation rate, whereas OMV carried a 2.6% EM and a 1.5% reoperation rate. MVR had a low EM of 2% when performed for predominant MR but a high EM of 11.3% when performed for predominant MS. The presence of an LA thrombus was an independent predictor of high mortality, being 21%. Mitral valve repair for rheumatic MR carried a low EM 0% but a high reoperation rate of 55%. Conclusion: For patients with rheumatic MR, MVR is superior to valve repair and carries a low EM. Whereas for patients with MS, the primary aim is for an OMV, with valve replacement as a second choice since it carries a higher EM. Closed mitral valvotomy is indicated when facilities for balloon valvuloplasty/open valvotomy are lacking. Patients with an LA thrombus should be recognized as high risk.
Keywords: Rheumatic mitral valve, Surgery, morbidity and mortality, Libya