Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

Perfusion ◽  
2020 ◽  
Vol 35 (7) ◽  
pp. 649-657
Author(s):  
Biao-Chuan He ◽  
Ying-Jie Ke ◽  
Kan Zhou ◽  
Ze-Rui Chen ◽  
Jue Yang ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Venous Drainage ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Thoracoscopic Approach ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Drainage Group

Aim: The aim of this study was to investigate the feasibility, safety, and clinical effect of modified unicaval drainage for thoracoscopic reoperative isolated tricuspid valve repair, compared with conventional bicaval drainage. Methods: A total of 45 consecutive cases of patients who underwent thoracoscopic reoperative isolated tricuspid valve repair on beating-heart were enrolled and divided into two groups according to the different venous drainage (Group A: modified unicaval drainage, Group B: conventional bicaval drainage). A retrospective analysis of perioperative data and clinical outcomes were performed and all the surviving cases were followed up. Re-evaluation of echocardiography and electrocardiogram was performed prior to discharge, and at first month, sixth month, and every year follow-up. Results: The overall postoperative 30-day mortality was 4.5% in Group A and 8.7% in Group B. The postoperative tricuspid valve regurgitation grade of both groups decreased significantly from preoperative regurgitation grade, p < 0.001, without intergroup significant difference, p = 0.815. Follow-up duration ranged from 6 to 38 months, there was one death at 24 months in Group A, and another at 9 months in Group B, respectively. Nobody from both groups experienced reintervention for residual tricuspid regurgitation. No significant difference could be identified about the incidence of postoperative morbidities and follow-up adverse events. Conclusion: Both strategies of caval venous drainage can provide satisfactory exposure for thoracoscopic reoperative isolated tricuspid valve repair and equivalent favorable postoperative outcome. And the modified unicaval drainage group may even preserve the anesthetic time and decrease the risk of iatrogenic jugular injury, achieving a more simplified procedure with better cosmetic outcome.

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

2019 ◽  
Vol 1 (4) ◽  
pp. 133-139
Author(s):  
Yasser Hamdy ◽  
Mohammed Mahmoud Mostafa ◽  
Ahmed Elminshawy
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Early Postoperative Period ◽  
Tricuspid Valve Repair ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

scholarly journals Comparison of Ring and Suture Annuloplasty in the Treatment of Tricuspid Regurgitation

2021 ◽  
Author(s):  
Mateus Tamba ◽  
Quinling Fu ◽  
Kaili Han ◽  
Xiaoke Sun ◽  
Liang Zhang ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Optimal Method ◽  
Ring Group ◽  
Wilcoxon Rank Sum Test ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Suture Group

Background: Significant TR is common in patients with cardiac disease and because of its prognostic importance, TV came to the spotlight in the last decades. Functional TR is mostly treated when undergoing left-sided valve surgery, whereas idiopathic TR surgery is uncommon. The aim of this study is to compare the durability of tricuspid valve annuloplasty techniques, and to explore the optimal method for TV repair surgery. Methods: 1005 patients who underwent tricuspid valve repair from February 2012 to March 2019, were retrospectively studied. The patients had tricuspid valve repair while receiving surgery for other cardiac conditions. The study population was divided into Suture group (n=483, 48.1%), and Ring group (n=522, 51.9%). Data variation between and within the groups was analyzed with Mann-Whitney U test, Wilcoxon rank-sum test, and Radit analysis. Results: At two-year follow-up, in the Suture group, none/trace TR subjects were 63.9%, and 1.4% had severe TR; In the Ring group were: 63.9% none/trace, and 0.6% severe. Both groups’ two-year follow-up TR status was significantly different with preoperative TR status (p<0.05). At two-year follow-up, Suture group had 63.9% none/trace and 1.4% severe; and Ring group had 63.9% none/trace and 0.6% severe TR and there was no significant difference between the groups (p>0.05). Conclusions: Both annuloplasty techniques have good short-term outcomes. However, suture annuloplasty deteriorates faster than ring annuloplasty, making the latter to be the ideal technique for TV repair.

Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

2021 ◽  
pp. 1-11
Keyword(s):  
Scale Score ◽  
Neck Disability Index ◽  
Implant Removal ◽  
Odontoid Fractures ◽  
Significant Difference ◽  
Flexion Extension ◽  
Group A ◽  
Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

scholarly journals Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair

2018 ◽  
Vol 26 (11) ◽  
pp. 552-561 ◽  
Author(s):  
R. Jansen ◽  
B. R. van Klarenbosch ◽  
M. J. Cramer ◽  
R. C. A. Meijer ◽  
P. H. M. Westendorp ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Repair

scholarly journals Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Hwa Jun Kang ◽  
Hong-Geun Jung ◽  
Jong-Soo Lee ◽  
Sungwook Kim ◽  
Mao Yuan Sun
Keyword(s):  
Hallux Valgus ◽  
Screw Fixation ◽  
Fixation Method ◽  
Kirschner Wires ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

scholarly journals A study to evaluate and compare the expulsion and continuation rates of post placental insertion of Cu 375 and CuT 380A in Indian women at a premier hospital in New Delhi, India

2017 ◽  
Vol 6 (9) ◽  
pp. 3992 ◽  
Author(s):  
Mansi Kumar ◽  
Mahesh Kumar ◽  
Parul Aggarwal ◽  
Archna Gangania ◽  
Rupali Dewan
Keyword(s):  
Removal Rate ◽  
New Delhi ◽  
Contraceptive Device ◽  
Indian Women ◽  
Significant Difference ◽  
Group A ◽  
Post Placental ◽  
Group B ◽  
Continuation Rates

Background: The Study was planned to evaluate and compare the expulsion and continuation rates of post placental insertion of Cu 375 and CuT380A in Indian women at Safdarjung Hospital New Delhi, after approval was obtained from Institutional Ethical committee.Methods: Study group consisted of 300 women, divided into two groups: Group A and Group B. The data was analysed by using ‘student “t” test/ non-parametric ‘Wilcoxon Mann Whitney’ for quantitative variables to evaluate the safety, efficacy and acceptability.Results: Mean age was 24.99 years (range: 19-35years), All women were married (off which 64% literate) and Mean parity in group A was 1.97 and 2.06 in group B. Mean pain score during intrauterine contraceptive device (IUCD) insertion on visual analogue scale was 2.93 in group A and 3 in group B and was not statistically different. 84% women completed 12 months follow up in group A and 83.33% women in group B. Strings were visible in 74% women in group A and in 34% women in group B at 1 month of IUCD insertion. Visibility of strings increased in successive follow up visits and was visible in >80% of women at the end of one year in the both groups. String visibility after intra-Caesarean insertion was delayed. Fifty one percent (n=77) subjects in group A and 54% (n=81) in group B experienced amenorrhea up to six months. Menorrhagia was reported in 7.33% in group A and women 8.66% in group B at the end of 1 year of follow up. Pain was complained by 26 out of 150 (17.3%) women in group A as compared to 36 out of 150 (24%) women in group B after 1 month of insertion. There was no case of PID in group A whereas there were 3 cases of PID in group B. There was no perforation/trauma and pregnancy in either group.Conclusions: Overall expulsion rate was 13% and removal rate was 5% in our study. Continuation rate was 83.3% in Cu 375 and 80.6% in CuT380A at 12 months. There was no significant difference between the IUCDs regarding the safety, efficacy and complications such as expulsion, bleeding etc.

Comparison of the Effects of Two Different Hollow Nails in the Treatment of the Young Pauwels Type Ⅲ Femoral Neck Fractures

2021 ◽  
Author(s):  
WENJING CHENG ◽  
GUOZHENG - DING
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Harris Hip Score ◽  
Avascular Osteonecrosis ◽  
Significant Difference ◽  
Group A ◽  
Random Number Table ◽  
Screw Withdrawal ◽  
Group B

Abstract Background: At present, there is a higher complication rate after treatment of femoral neck fractures with three parallel hollow nails (PHN) in the young Pauwels type Ⅲ femoral neck fractures.For better effect,F-shape hollow nails(FHN) is used to treat femoral neck fractures.The purpose of this study is to compare the clinical efficacy of FHN and PHN and provide reference for clinical application.Methods: Thirty-eight consecutive patients admitted from January 2017 to January 2020 were selected for the study. According to random number table method, the patients were divided into two groups:group A (FHN) and group B (PHN). The gender, age, BMI, comorbidities, time from injury to operation and other general preoperative demographics were not statistically different (P>0.05). The data of the two groups can be comparable.The occurrence of avascular osteonecrosis of the femoral head (AVN), femoral neck shortening, hollow screw withdrawal was recorded in follow-up.Then, Harris hip score (HHS), pain visual analog score (VAS) of two group were obtained at the last follow-up. Results: The mean follow-up period after surgery was 21.4±10.1 (range, 14–29) months. There were 18 cases(mean age, 47.5±9.6) in group A, 20 cases (mean age, 48.6±10.1) in group B. There was no significant difference between the two groups in AVN, femoral neck shortening (P>0.05), the two groups had statistically significant differences in screw withdrawal (F=4.416, P<0.05). There was no significant difference in HHS and VAS between the two groups at the last follow-up (P>0.05).Conclusion: Three parallel hollow nails (PHN) and F-shape hollow nails (FHN) have similar short-term effects in the young Pauwels type Ⅲ femoral neck fractures, but the nail withdrawal rate of FNH is lower.

Treatment of Major Laparoscopic Bile Duct Injury: A Long-Term Follow-up Result

2011 ◽  
Vol 77 (12) ◽  
pp. 1584-1588 ◽  
Author(s):  
Xiao Dong Xu ◽  
You Cheng Zhang ◽  
Pen Gao ◽  
Farah Bahrani-Mougeot ◽  
Ling Yi Zhang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Tertiary Care ◽  
Secondary Operation ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Group D

The goal of this study is to present the multiple institutions experience comparing the outcome of management between initial laparoscopic cholecystectomy (LC) surgeon and specialist as well as the outcome of different operative procedures to major bile duct injury (BDI) after LC. We have retrospectively collected data of 77 cases of perioperatively detected major BDI in LC at 15 general surgical institutions from 1997 to 2007. We classified 42 cases treated by an experienced biliary surgeon as Group A and 35 cases treated by the initial LC surgeon as Group B. Forty-eight cases were treated with duct-to-duct anastomosis as Group C and 29 cases were treated with Roux-en-Y choledochojejunostomy as Group D. The median duration of follow-up was 62 months. The outcome of groups was compared. In Group A, 7 of 42 (16.7%) patients developed a failure. Two of seven (28.6%) patients were treated by a secondary operation. In Group B, 24 of 35 (68.6%) patients developed a failure. Seventeen of 24 (70.8%) patients were treated by a secondary operation. One of 35 (2.85%) patients died. The significant differences were observed in failure and secondary operations (16.7 vs 68.6%, P < 0.01 and 28.6 vs 70.8%, P < 0.01). There is no significant difference Group C and Group D in failure rate (28.5 vs 11.7%, P > 0.05). A multiple institutional cooperative methodology between the local surgical institution and tertiary care centers provided a good way to limit further operations, failure. The reconstructive strategy is important and should be selected according to the type of injury and the diagnosed status of major BDI.

scholarly journals A Comparative Study on Efficacy of Polymyxin B, Neomycin and Polymyxin B, Neomycin, Hydrocortisone in the Treatment of Otitis Externa at Nepal Medical College and Teaching Hospital, Kathmandu

2017 ◽  
Vol 2 (2) ◽  
pp. 162-167
Author(s):  
Mayuri Gupta ◽  
S Aryal
Keyword(s):  
Teaching Hospital ◽  
Otitis Externa ◽  
Clinical Signs ◽  
Polymyxin B ◽  
Medical College ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Cure Rates

IntroductionAcute otitis externa (AOE) is a common but preventable ear condition. Tenderness with movement of the tragus or pinna is a classic feature of otitis Externa. Polymyxin B, neomycin, hydrocortisone preparations are the choice for first-line therapy when the tympanic membrane is intact. This study atiempted to compare the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa.ObjectiveTo compare the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa.MethodologyTo evaluate the efficacy of polymyxin B, neomycin and polymyxin B, neomycin, hydrocortisone in the treatment of otitis Externa, a hospital based, randomized, prospective study was conducted in Nepal Medical College and Teaching Hospital (NMCTH), Atiarkhel, Kathmandu from August 2012 to May 2014. 70 outpatients suffering from otitis Externa who met the inclusion and exclusion criteria were included. Patients were randomized into group A and group B with lotiery system. Odd number patients were included in group A and even number patients in group B. Group A patients received pack soaked with ribbon gauge in polymyxin B, neomycin ointment and Group B patients received pack soaked with ribbon gauge in polymyxin B, neomycin, hydrocortisone ointment. The patients were called for follow up after 48 hours and 96 hours to assess the improvement on the basis of tragal and circumduction tenderness either present or absent (present 1 or absent 2). A decrease in the clinical signs and symptoms (i.e. tragal and circumduc_on tenderness) was noted. Absence of pain was considered as clinically cured.ResultsIn comparison to polymyxin B, neomycin group, hydrocortisone group exhibited statistically significant effectiveness after 48 hours of treatment (p<0.05), but in cure rates after 96 hours, no statistical significant difference was observed between two groups (p>0.05).ConclusionPolymyxin B, neomycin, hydrocortisone group showed higher and faster cure rates than polymyxin B, neomycin group in the treatment of otitis Externa at 48 hours follow up. Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, Page: 162-167 

P1755 Clinical and echocardiographic outcomes of mitral valve repair surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Garcia Bras ◽  
L Moura Branco ◽  
P Coelho ◽  
V Vaz Ferreira ◽  
A Castelo ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Nyha Class ◽  
Left Ventricular Ejection ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Replacement Surgery ◽  
All Cause Mortality ◽  
Mean Time

Abstract Background Mitral valve regurgitation (MVR) represents the second most frequent valvular heart disease. MV surgical repair is often the preferred treatment when MV anatomy is suitable. Purpose To characterize the population who underwent MV repair surgery and evaluate the outcomes of residual MVR, allcause mortality and functional classification. Methods Retrospective analysis of 262 patients (P) admitted between 2008 and 2017 for MV repair surgery. P who undergone simultaneous coronary artery bypass graft (CABG) surgery, atrial fibrillation (AF) surgery and tricuspid valve repair were also included. P with endocarditis, P who underwent simultaneous aortic valve replacement and P with rheumatic predominant MV stenosis were excluded, the remaining 204 P were analysed. Clinical and echocardiographic characteristics were evaluated in a mean follow-up of 30 months. Results 204 P, 67.2% male, mean age 62 + 14 years. The most frequent etiology was organic (80.4%), mostly of degenerative cause. Functional etiology was present in 19.6%, mostly ischemic (72.4%). 16.8% underwent simultaneous CABG, 12.3% tricuspid valve repair and 7.8% AF ablation. Hypertension was significantly associated with functional etiology (90% vs 72.8%, p = 0.022), as well as hypercholesterolemia (80% vs 48.2%, p &lt; 0.001) and diabetes mellitus (32.5% vs 10.4%, p &lt; 0.001). Baseline left ventricular ejection fraction (LVEF) was &gt;50% in 78.4%, reduced (30-50%) 18.1% and poor (&lt;30%) in 3.4%. Functional etiology was significantly associated with LVEF &lt;50% (70% vs 9.1%, p &lt; 0.001). 161P (78.9%) had MV prolapse: 120P (74.5%) posterior, 29P (18%) anterior and 7.4% (12P) of both leaflets. P2 was the most frequently involved scallop, in 92P (57.1%), followed by P3, in 41P (25.4%). There was MV chordae rupture in 94P (58.3%). Post-surgery echocardiography revealed that 93.8% had mild or no residual MVR. 30-day mortality rate was 0%. There was MVR recurrence with MV replacement surgery in 15P (7.5%), mean time 37.1 months. All-cause mortality was registered in 28P (13.7%), with a mean time of 43.7 months after MV surgery. Of the P without MVR recurrence or mortality, 111P (70%) were in NYHA class I, 41P (26%) in NYHA class II and 6P (4%) in NYHA class III. 6P were lost to follow-up. Upon echocardiographic revaluation there was no residual MVR in 53P (39%), mild MVR in 67P (49%) and moderate MVR in 16P (11.8%). Conclusion In P who underwent MV repair surgery, there was 7.5% recurrence rate with follow-up MV replacement surgery and an all-cause mortality of 13.7%. In a mean follow-up of 30 months, 70% of P were in NYHA I class and there was none or mild residual MVR in 88% of P.

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