Left ventricular dimension changes after chordal preservation in mitral valve replacement

Clinical and experimental evidence regarding the benefits of preserving the subvalvular apparatus during mitral valve replacement has been debated. Reductions in the left ventricular end-diastolic dimensions have been shown, by echocardiography, to correlate well with the levels of clinical improvement following successful valve surgery. Seventynine patients underwent mitral valve replacement for mitral stenosis, regurgitation or both. In 42 patients, a conventional valve replacement was performed, excising both leaflets along with their chordae. In the remaining 37, a modified technique was used preserving the posterior leaflet and chordae. The two groups did not differ significantly in their demographic profiles, clinical classes and pathology. Echocardiographic assessment of left atrial and left ventricular dimensions was done preoperatively and prior to discharge. Median left atrial dimensions decreased in both groups. Postoperatively, the left ventricular end-diastolic and end-systolic parameters remained either the same or showed an increase in the conventional group. Patients in the modified group, however registered a decrease in left ventricular dimensions. Such changes further supported the clinical evidence suggesting benefits of preserving the chordae tendinae in mitral valve replacement.