Depok, July 12th 2023. dr. Budi Rahmat, SpBTKV(K)-P., presented his dissertation about “Usage of Anulus Posterior Elevation Technique in Reducing Residual Regurgitation on Pediatric Mitral Valve Repair” during the open session of doctorate promotion conducted by the Doctorate Program of Faculty of Medicine Universitas Indonesia (FKUI).
Mitral valve is a valve that connects the left atrium and left ventricle of a heart. Regurgitation on the mitral valve causes the left ventricle unable to pump the blood optimally, which may lead to an added pressure on the heart’s muscle and obstruction of blood flow. If the regurgitation is not treated, the ventricles might lost their function and it will end with heart failure.
Medical operation to treat mitral valve regurgitation has always been done by swapping the mitral valve to a prosthetic one. However, as human’s understanding about the anatomy, function, and pathophysiology of mitral valve grow rapidly, there is a change of strategy in the operation for mitral valve regurgitation. Instead of swapping the valve, the valve will be repaired. This repair is considered to be more beneficial: less mortality rate for both early and late aged patients; better function preservation on the left ventricle; and low chance of blood clot, complication due to anticoagulant, and heart infection.
In his presentation, dr. Budi said, the previous study (Baghaei et al, 2015) reported that with the current conventional operation technique, the percentage of post-operation residual mitral valve regurgitation happening is 62.3%. Additionally, according to data from Pediatric Heart Surgery Unit, National Cardiovescular Center Harapan Kita, the percentage of post-operation residual mitral valve regurgitation happening is 49%.
“It happens when the contact area between the flap of both mitral valves is not optimal. Post-operation residual mitral valve regurgitation can cause several negative impacts, namely heart failure, damaged blood cells, and hindering the post-operation recovery,” stated dr. Budi.
In the face of those problems, dr. Budi Rahmat done a research on mitral valve operation using the mitral valve anulus posterior elevation technique to elevate the contact are of both mitral valve, in order to lower the risk of post-operation residual mitral valve regurgitation. The research was done on 64 patients that were separated into two groups: one with the mitral valve anulus posterior elevation technique and the other one with conventional operation technique.
“The mitral valve anulus posterior elevation technique is done by elevating the mitral’s anulus posterior which allows both flaps of the valve to meet perfectly. This technique has never been done on pediatric mitral valve repair operation before, yet it is quite easy and affordable to do,” said dr. Budi.
The result shows that the anulus posterior technique is effective in reducing residual mitral regurgitation, increasing coaptation length index, and has the potential to improve the result of mitral valve regurgitation surgery on children for a long time. Moreover, the usage of additional substances in this technique does not cause any side effect, which is indicated by similar hemolysis marker post-operation.
In his speech as a promotor, Prof. Bambang announced the result of this research as a breakthrough in pediatric heart valve operation. With only a slight modification in operation through anulus posterior elevation technique, we can significantly reduce the risk of post-operation residual mitral valve regurgitation.
