Pishchurin O. Valve sparing operations in congenital insufficiency of the mitral valve.

The dissertation is dedicated to the actual problems of surgical treatment of congenital mitral valve insufficiency (CMVI) by surgical correction. On the basis of study of 75 patients, which underwent plastic correction of the CMVI lesion in M.M. Amosov Institute of Cardiovascular surgery of the Academy of Medical Sciences of Ukraine during the period from 1993 to 2002 the clinic-hemodynamic features of the CMVI and the characteristics of its combinations with other congenital heart anomalies were studied. A systematization of mitral valve structural changes, due to their congenital insufficiency was elaborated. The systematization is based on the relations definition of the level of systolic coaptation of leaflets to the plane of the fibrous ring. Depending on the anatomical type of disease the optimal valve sparing correction methods were established, considering the most effective primary and additional ways of correction. The immediate and the remote postoperative results of valve sparing operations of CMVI were analyzed. The efficiency of the surgical interventions and unsatisfactory results reasons were estimated and the most difficult for correction types of the lesion were revealed. As a result of the fulfilled work the efficiency of the surgical treatment of CMVI by plastic correction had increased. The implementation of new technical principals in the group of its consecutively operated on patients with the CMVI resulted in the decrease of the frequency of mitral valve replacement from 21,4% in the initial stage of the study (1993-1997) to 8,6% in the final stage of the study (1998-2002).