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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina


N. Radovanović, S. Ničin, Lj. Petrović, B. Mihajlović, M. Zorc1, V. Torbica, J. Selestiansky, P. Kovačević, M. Fabri and M. Popov.
University Clinic of Cardiovascular Surgery, Novi Sad, Yugoslavia, Institute of Histology1, Medical Faculty, Ljubljana, Slovenia

Background: The pathogenic mechanism of chronic mitral regurgitation is considered to be due to the combination of papillary muscle dysfunction left ventricular and annular dilatation and myocardial dyskinesia. These processes lead to remodelling of the fibrous skeleton of the heart, which is an important part of remodelling of the left ventricle. We have reviewed our group of 163 operated patients with chronic ishemic dilated cardiomyopathy (IDCM), ejection fraction (EF) below 30% and mitral regurgitation.

Methods: There were 163 male (92%) and 15 female patients, aged 34-70, with the mean age of 56,2 years. The mean EF was 23,0 = 4,9% male, and the mean ventricular diastolic internal diameter 7,0 cm. Among those, 71% (126/178) had signs of congestive heart failure before surgical therapy. All patients had undergone myocardial revascularisation and Reductive Annuloplasty of Double (mitral and tricuspid) Orifices (RADO). Our technique preserves normal shape and flexibility of the mitral and tricuspid valve corrects remodelling of the fibrous skeleton on the base of the heart and changes the geometry of the left and right ventricle. Results: Postoperative mortality- 30 days was 5,0% (9/178). Closing date of the follow-up study was February 15, 1998. The study was done for 117 patients. The average time of follow-up was 30 months (0-132). Survival rate was 53,5±5,9% at 5 years and 42,4 ±7,4% at 10 years

Conclusions: According to our experience with 178 operated patients, we conclude that this severe group of patients with dilated cardiomyopathy, ishemic mitral regurgitation and ejection fraction below 30% can be operated with low operative risk. After RADO and optimal myocardial revascularisation a significant improvement in all hemodynamic parameters was observed as well as good long-term results.

Drugi kongres kardiologa i angiologa Bosne i Hercegovine
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