Mitral Valvuloplasty With Carpentier's Techniques

From January 1992 to January 1997, 586 patients with mitral incompetence were treated by Carpentier's techniques in the Heart Institute of Ho Chi Minh City, Vietnam. Ages ranged from 6 to 60 years (mean, 26.4 ± 9.9 years) and 124 patients were younger than 15 years of age. Mitral valve incompetence was classified into three types according to leaflet pliability: type I, normal leaflet motion, 7 cases (1.2%); type II, leaflet prolapse, 185 cases (31.6%); type III, restricted leaflet motion, 394 cases (67.2%). Associated tricuspid valvular disease was present in 337 cases (57.5%). Mitral valve prosthetic ring annuloplasty was used in 532 cases (90.8%). The operative mortality rate was 1.9% (11/586). According to the New York Heart Association functional classification, 3.9% (23/586) of the patients were in class I, 52% (305/586) were in class II, 42.3% (248/586) were in class III, and 1.7% (10/586) were in class IV. Mitral valve disease was due to rheumatic fever in 96.7% of the patients. Follow-up data were available in 572 patients from 1 year to 5 years (mean, 38 months). The late mortality rate was 0.7% (4/572). Morbidity comprised endocarditis in 2 patients, one patient had a cerebral hemorrhage, and 16 patients underwent reoperation for recurrent mitral incompetence (incorrect operative indication). There were 2 incidents of thromboembolism. Patient selection was based on valvular disease rather than age, physical condition, or cause of valvular disease. The low mortality and complication rates in this series confirm that mitral valve reconstruction by Carpentier's techniques was appropriate for the patients with mitral incompetence, particularly for children.