Gestionarea insuficienţei mitrale funcţionale în timpul inlocuirii valvei aortice

Abstract

Background: The article describes the literature about functional mitral insufficiency associated with surgical approach in aortic valve pathology – which is an actual problem regarding incidence of this pathology simultaneously to aortic valve pathology. This work includes etiologic and physiopathologic aspect, contemporary principles of diagnosis and treatment, surgical technique depending upon mechanism of functional mitral insufficiency origin and elucidation of predictors’ factors screening criteria in progression or regression of mitral insufficiency. In the course of study predictors of mitral insufficiency evolution, gradient pressure of aortic valve, mitral valve ring diameter, presence of arrhythmias, ejection fraction of left ventricle and ventricular mass were determined. The proof of the effect of mitral valve failure after the replacement of aortic valve is the symptom of profound left ventricle pathology. Therefore echocardiological parameters of the left ventricle dysfunction, especially of diastolic one, may be predictor of mitral failure effect in case of surgical approach to the aortic valve. Conclusions: Decrease of functional mitral insufficiency is expected in the majority of cases after aortic valve replacement, but decrease grade depends upon all predictors’ factors that were studied. At present there is no evidence that coexistent postoperative mitral insufficiency can affect survival, but the impact upon the symptoms is still unclear. A complete evaluation of long term functional state is still an important field of study.