[The effect of subvalvular apparatus preservation on the hemodynamic function of the heart in the early postoperative period after prosthetic mitral valve replacement].

Left ventricular function was compared in 27 patients who had conventional mitral valve replacement--cMVR (group I) and 24 patients who had modified mitral valve replacement with preservation of chordae tendineae and papillary muscles--mMVR (group II) (Tab. 1). In group I 12 patients were operated on because of isolated mitral stenosis (group Ia) and 15 patients due to mitral insufficiency (group Ib). In group II mitral stenosis was indication for operation in 5 patients (group IIa) and mitral insufficiency in 19 patients (group IIb) (Tab. 2). In each group pre- and postoperative values of stroke volume, stroke volume index, right ventricular stroke work index, left ventricular stroke work index and the need for inotropic support were compared (Tab. 5). Patients after cMVR (group I) showed decreased values of all compared indices. 59.3% of patients in this group needed inotropic support in early postoperative period. This tendency was more prominent in group Ib (mitral insufficiency) than in group Ia (mitral stenosis). Patients in group II did not show significant differences between pre- and postoperative hemodynamic data except significantly increased stroke volume and right ventricular stroke work index in group IIb. 41.7% of patients in group II needed inotropic support. Summing up, left ventricular function deteriorated after operation in the group with subvalvular apparatus excised. The deterioration was especially significant in the patients operated on because of mitral insufficiency.