[Long-term course after Carpentier's reconstructive mitral valvuloplasty in mitral valve insufficiency in adults. Apropos of 12 patients operated on over 16 years].

Twelve patients (5 men with a mean age of 51 years and 7 women with a mean age of 40 years) suffering from severe or massive mitral valve insufficiency (MI) either pure (5 cases) or strongly predominant (7 cases) and associated in 9 cases with tricuspid valve insufficiency (TI) had undergone surgery more than 15 years previously (mean follow-up time: 16 years 4 months). The surgery performed consisted of Carpentier's reconstructive mitral valvoplasty which was completed in 8 cases by the insertion of a tricuspid anuloplasty. Prior to surgery, all these patients were at NYHA stage III (4) or IV (5). On the basis of peroperative observations, five patients had highly predominant MI, probably of rheumatic etiology (6 men and 1 woman); the other 5 patients (4 men and 1 woman) presented with MI dystrophy, accompanied in 3 cases with tearing of the chordae of the lesser valve. One patient (63 years of male patient) died 36 hours after surgery (8%). Two patients died during the monitoring period (1 sudden death, 6 years after surgery and 1 case of digestive tract cancer, 11 years after surgery). Two patients had to undergo further surgery, one 8 years later (rheumatic mitral insufficiency, which had again become severe) and the other 10 years after surgery (very severe aortic valve insufficiency, the MI remaining moderate). The patients were followed up at 6-monthly consultations. The rapid functional improvement (to stages I or II) was sustained. In all but one case (involving repeat surgery), the MI remained mild to moderate, as did the corrected TIs (clinical data and ultrasound cardiography).(ABSTRACT TRUNCATED AT 250 WORDS)