Moroz V. Mitral regurgitation in ischemic heart disease, algorithm of diagnosis and surgical treatment

In the dissertation a theoretical generalization and a new solution of the problem of cardio-varcular surgery regarding increasing the effectiveness of surgical treatment of patients with coronary heart disease in the presence of ischemic mitral regurgitation by developing differentiated indications for performing certain surgical interventions on the mitral valve under the conditions of myocardial revascularization are carried out. The peculiarities of the influence of concomitant pathology on the clinical course of ischemic mitral regurgitation and on the choice of surgical tactics for mitral valve correction are established. It was found that the frequency of moderate and severe left ventricular hypertrophy, as well as concentric remodeling of the left ventricle, are characteristic of the group of patients who underwent mitral valve replacement. Identified clinical features of the course of ischemic mitral regurgitation that distinguished the participants of the control group from the experimental group by: an earlier age of onset of arterial hypertension by 4.8 years and, accordingly, a longer experience of it by 5.7 years; significantly higher frequencies of arterial hypertension of the III degree (p = 0.008, χ2 = 6.93), myocardial infarction (p = 0.04, χ2 = 4.09) and significant mitral insufficiency (p = 0.03; χ2 = 4, 69). Structural and anatomical changes of the mitral valve were established, which had statistical significance in patients of the control group, namely: prolapse of the anterior leaflet (p = 0.04; χ2 = 4.0) and both leaflets (p = 0.02; χ2 = 5 ,24); frequency of calcinosis (p = 0.006; χ2 = 7.58); calcinosis of the ring (p = 0.01; χ2 = 5.58); and severe mitral valve insufficiency (р = 0.03; χ2 = 4.69). Clarified reliable features that characterize patients who underwent mitral valve replacement are: moderate degree of mitral insufficiency (р = 0.05; χ2 = 3.74); myocardial hypokinesis (p = 0.001; χ2 = 10.75) and mild hypokinesis (p = 0.008; χ2 = 6.94). Echocardiographic differences in the structure of the mitral valve were established, which influenced the selection of the intervention volume. It was established that in the patients of the experimental group, the following clinical, functional and morphological changes were reliably significant: a moderate degree of severity of left ventricular, a decrease in left ventricular systolic function, anterior leaflet prolapse and, in general, the proportion of prolapses of any type, and it was also found that the lesion of the fibrous ring mitral valve deposits of calcium were insignificant. It was found that in the patients of the experimental group, the early postoperative mortality and the duration of inpatient treatment were significantly higher than in the patients of the control group, which indicates the imperfection of the criteria used by cardiac surgeons when choosing the tactics of surgical correction of the mitral valve, trying to perform an organ-preserving operation. An algorithm for a differentiated approach to choosing a technique for effective surgical mitral valve correction in patients with ischemic mitral regurgitation and coronary heart disease is proposed.