Denervation of pulmonary trunk and pulmonary orifice in patients with surgically corrected mitral valve disease against high pulmonary hypertension

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Abstract

Aim: To study efficacy and safety of denervation of the trunk and pulmonary arteries (PADN procedure) in patients with surgical correction of the mitral valve against a high degree of pulmonary hypertension compared to those of the isolated correction of mitral valve disease.

Materials and methods: Placement of a mechanical mitral valve prosthesis and radiofrequency ablation Maze IV with Atri Cure ablator was performed in 39 patients with a mitral valve disease and high pulmonary hypertension (> 40 mm Hg) and atrial fibrillation. From those, 8 patients (main group) had additional circular denervation of the ganglionic plexus of the pulmonary trunk and orifice (PADN) with a radiofrequency bipolar Atri Cure ablator under the control of transmurality.

Results: All patients who had underwent surgery showed positive changes of the echocardiographic parameters, such as a decrease in the heart cavities sizes, degree of pulmonary hypertension, and an improvement in the systolic function of the left ventricle. There were no deaths, as well as specific complications related to the PADN procedure. In the main group of patients (n = 8), pulmonary hypertension decreased from 56.3 ± 5.4 mm Hg to 23.4 ± 2.7 mm Hg at day 1, to 24.3 ± 3.1 mm Hg at day 7, and to 23.7 ± 3.8 mm Hg at 1 month after the PADN procedure. At day 1, the target levels of pulmonary hypertension were achieved in 87.5% (7/8) of patients in the main study group and in 25.8% (8/31) of patients in the control group (p = 0.001). At day 7, the corresponding values were 75% (6/8) and 32.3% (10/31), respectively. Better results in the main study group were observed throughout the whole follow-up period (up to 2 months).

Conclusion: The circular PADN procedure using a radio frequency bipolar ablator under the control of transmurality is an effective and safe method to correct a high-degree pulmonary hypertension. Further studies on the effectiveness of this procedure in larger patient numbers and assessment of long-term results are necessary.

About the authors

N. A. Trofimov

Republican Cardiology Dispensary

Author for correspondence.
Email: nikolai.trofimov@mail.ru

MD, PhD, Cardiovascular Surgeon

29А Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation. Tel.: +7 (8352) 56 10 03

Россия

A. P. Medvedev

Nizhny Novgorod State Medical Academy

Email: mail@skkbnn.ru

MD, PhD, Professor, Head of Chair of Hospital Surgery named after B.A. Korolyov

209 Vaneeva ul., Nizhny Novgorod, Nizhegorodskaya oblast', 603950, Russian Federation. Tel.: +7 (831) 417 77 90

Россия

A. G. Dragunov

Republican Cardiology Dispensary

Email: fake@neicon.ru

MD, PhD, Head of Department of Cardiac Surgery No. 2

29А Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation

Россия

V. E. Babokin

Moscow Regional Research and Clinical Institute (MONIKI)

Email: babokin@bk.ru

MD, PhD, Head of Department of Cardiac Surgery

61/2 Shchepkina ul., Moscow, 129110, Russian Federation. Tel.: +7 (495) 631 72 23

Россия

A. V. Nikol'skiy

Nizhny Novgorod State Medical Academy

Email: fake@neicon.ru

MD, PhD, Cardiovascular Surgeon

10/1 ploshchad' Minina i Pozharskogo, Nizhny Novgorod, Nizhegorodskaya oblast', 603005, Russian Federation

Россия

T. N. Mizurova

Republican Cardiology Dispensary

Email: fake@neicon.ru

MD, Cardiologist, Chief Physician

29А Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation

Россия

M. V. Gartfelder

Republican Cardiology Dispensary

Email: fake@neicon.ru

MD, Cardiovascular Surgeon

29А Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation

Россия

A. V. Orlova

Federal Center of Traumatology, Orthopaedics and Prosthetics (Cheboksary)

Email: fc@orthoscheb.com

MD, PhD, Specialist in Medical Methodology

33 Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation. Tel.: +7 (8352) 30 57 57

Россия

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Copyright (c) 2017 Trofimov N.A., Medvedev A.P., Dragunov A.G., Babokin V.E., Nikol'skiy A.V., Mizurova T.N., Gartfelder M.V., Orlova A.V.

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