Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy

Abstract

Background: There is a lack of established pathological indications for rheumatic valve repair. Therefore, we summarized the pathological classifications of rheumatic heart diseases and their correlations with the surgical strategies. Methods: This observational study enrolled patients with rheumatic heart diseases who underwent mitral valve repair (MVP) or replacement at our centre between January 2017 and January 2019. Mitral leaflet, mitral commissural, and sub-valvular apparatus were classified into three grades from mild to severe, according to their degree of pathological damage. Based on certain principles and the grade of mitral leaflet, mitral commissural, and sub-valvular apparatus damage, three pathological types were identified (types I to III), based on which all patients were classified. The features of each pathological type were summarised.Differences between the three pathological types were analysed using chi-square test of tendency. These data were used to propose a clinico-pathological classification of rheumatic mitral valve damage in Chinese patients. Results: Of 398 patients, 284 (70%) underwent MVP for rheumatic mitral valve diseases. There were 58 type I (15%) patients in the study, all of whom underwent repair (repair rate, 100%). Preoperative moderateto-severe regurgitation with mild pathological lesions was observed in 64% of these patients. In 260 type II (65%) patients, the repair rate was 76% (197/260); preoperative moderate-to-severe stenosis was observed in 88% of these patients. In 80 type III (20%) patients, the repair rate was 36% (29/80); the preoperative rates of extremely severe stenosis and moderate-to-severe regurgitation in these patients were 50% and 40%, respectively. Several preoperative parameters show the change in trend with the increase in the pathological classification severity. Conclusions: Our clinico-pathological classification of rheumatic mitral valve damage is applicable to MVP. Considering that the classification principles are based on the possibility of mitral repair, it provides a phased and achievable target ratio for MVP and a principle of screening patients who should undergo rheumatic MVP.

Short and mid-term effects of modified release technique in rheumatic mitral valve repair

“…From January 2018 to July 2021, patients with Type III rheumatic mitral valve stenosis [ 10 ]who underwent heart surgery by Dr. Cao in Nanjing Drum Tower Hospital were selected, our team performed 264 mitral valve repair and 285 mitral valve replacement in these patients. Concomitant atrial radio-frequency ablation, tricuspid valve repair, aortic valve repair, or replacement was not excluded.…”

Valvulopatía reumática: principios, fisiopatología y tratamiento

“…La clasificación patológica va a depender de cuál de las estructuras de la válvula está involucrada (valva, comisura, área subvalvular). Esta es específica para la válvula mitral (10). La enfermedad reumática valvular también puede afectar la válvula aórtica y generar regurgitación aórtica con simultánea regurgitación mitral, generando así un gran cambio en la fisiología de la dinámica de fluidos en las cámaras izquierdas (11).…”

“…Cuando las tres categorías se clasifican como clase uno, el tipo patológico es el tipo I. Cuando al menos una de las tres categorías es considerada tipo dos, se denomina tipo II. En el momento en el que dos o más de las clases patológicas se clasifican como tipo tres, se considera tipo patológico III (10), ver tabla 1.…”

“…Luo T, Meng X. Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy. J Thorac Dis (10).…”