International Ballroom Center

3:00 P.M. Scientific Session: REGULAR PROGRAM

International Ballroom Center

Address by the President

Hiram T. Langston Chicago, Illinois

" - Of Cabbages and Kings"

Address by the Honored Speaker

Leo Eloesser

Tacambaro, Michoacan, Mexico

"Milestones in Chest Surgery"

Milestones that have marked new paths in chest surgery, impulses and landmarks that guided their finders, and incidents of their discovery.

32. A New Reconstructive Operation for Correction of Mitral and Tricuspid Insufficiency

Alain Carpentier,* Paris, France

Sponsored by Dwight C. McGoon

The palliative nature of the reconstructive procedures actually used for the treatment of mitral or tricuspid insufficiency, is probably responsible for a somewhat high percentage of recurrent systolic regurgitation. A systematic attack of this problem was undertaken by careful analysis of the anatomical and functional disorders observed in such diseases, and a reconstructive operation to correct them was devised, using prosthetic rings suitably shaped and sized. This "semi-prosthetic" repair of the valve corrects the triad of defects that usually exists in a pure mitral insufficiency: (1) Backward position of the aortic leaflet (2) Enlargement of the commissure (3) Dilatation of the mitral annulus. This can be automatically achieved without reducing the normal orifice area nor altering the leaflet motion. In addition the use of a semi-rigid prosthetic ring prevents the risk of persistent dilatation of the annulus which is generally responsible for the recurrent insufficiency frequently observed in patients operated upon with usual techniques. Anticoagulant therapy is not required since the prosthetic ring is extremely thin and cloth covered. The same concept has been extended to the treatment of the tricuspid insufficiency and the mitral insufficiency due to ruptured chordae, or associated with mitral stenosis. Since October 1968, 30 patients were operated on using these techniques. Clinical results and hemodynamics findings will be presented.

33. The Comparison of Late Results of Reconstructive and Replacement Procedures for Acquired Mitral Lesions

William J. Kerth, Giridhari Sharma,* J. Donald Hill,*

and Frank Gerbode, San Francisco, Calif.

From 1957 to 1969, 430 open heart operations have been performed for acquired mitral valve lesions at this center. Before the availability of prosthetic valves, 76 valvuloplastic procedures were done for predominant mitral insufficiency. After 1962, 354 operations consisting of 211 valve replacements and 143 reconstructive procedures were performed. Early hospital mortality and the late results of surgery have been compared by the actuarial method after a follow-up up to 11 years for reconstructive procedures and seven years for mitral valve replacement. Hemodynamic data are available in 27 patients after valvuloplasty and 41 patients who had valve replacement. Comparison is also made with regard to the findings at 51 reoperations, (28 for reconstructive and 23 for replacement procedures), the incidence of early and late complications, and the functional status of patients after surgery. Valvuloplasty is the procedure of choice for mitral insufficiency due to ruptured chordae of the posterior leaflet and in cases with a significant cleft in the posterior leaflet as the cause of insufficiency. It still has a good deal of merit in other selected cases of pure mitral insufficiency in absence of stenosis, calcification and fibrosis. Long-term survival was better with reconstruction than with mitral replacement with the prostheses available at the time of these replacements.

*By Invitation

TUESDAY EVENING, APRIL 7, 1970

7:00 P.M. Reception

International Ballroom Center

8:00 P.M. Dinner and Dancing

International Ballroom Center

Attendance limited to Members of the Association and their ladies, Invited Speakers and their ladies, Invited Guests and their ladies

Dinner dress preferred