Yalda Mirmesdagh | Shahid Beheshti University of Medical Sciences (original) (raw)

Papers by Yalda Mirmesdagh

Research paper thumbnail of A rare presentation of late right coronary artery spasm following aortic valve replacement

ARYA atherosclerosis, 2015

Coronary artery spasm (CAS) is defined as a reversible, sudden epicardial coronary artery stenosi... more Coronary artery spasm (CAS) is defined as a reversible, sudden epicardial coronary artery stenosis that causes vessel occlusion or near occlusion. In this article, we present a clinical case of CAS in a 48-year-old woman undergoing elective aortic valve replacement surgery for aortic stenosis. On the 3rd post-operative day, the patient suffered from chest pain and dyspnea. Emergent coronary angiography demonstrated a significant spasm of the ostium portion of the right coronary artery. This case shows that delayed coronary spasm should be considered as a cause of hemodynamic instability after valvular surgery.

Research paper thumbnail of Surgical outcomes of heart valves replacement: A study of tertiary specialied cardiac center

ARYA atherosclerosis, 2014

Heart valve disease is a significant and increasing global problem in the developing world. The a... more Heart valve disease is a significant and increasing global problem in the developing world. The aim of this study is to evaluate the incidence of postoperative complications and mortality in patients who underwent heart valve replacement. In this prospective study, 320 adult cases (186 females and 134 males, mean age of: 45.7 ± 15.0) with valvular heart diseases who underwent heart valve replacement at our center, from June 2011 to January 2012 were enrolled. All the required demographic, echocardiographic, and electrocardiogram data were studied. The incidence of intraoperative and early postoperative complications and mortality were evaluated. Among total, 96.3% of the cases underwent elective surgery. Mitral valve replacement surgery was occurred the most in 58.8% of the cases. In 11.3% of the cases, bioprosthetic valves and in 88.8% of the patients prosthetic valves were required. Early postoperative complications were occurred in 85 patients (26.6%), including: valve-related ev...

Research paper thumbnail of Prevention of edema after coronary artery bypass graft surgery by compression stockings

Research in cardiovascular medicine, 2014

Lower limb edema may occur after removal of the saphenous veins in coronary artery bypass graft (... more Lower limb edema may occur after removal of the saphenous veins in coronary artery bypass graft (CABG) surgery. Compression therapy is often used to prevent postoperative edema. The objective of this study was to evaluate the efficacy of medical compression stockings (TED) on the prevention of donor limbs edema and wound complications after CABG surgery. In this prospective cohort study, we enrolled 100 patients who underwent elective CABG surgery at Rajaie Cardiovascular Medical and Research Center. The patients were divided into two groups; group A who applied TED stockings regularly (exposure group) and group B who did not apply TED stockings at all or apply it irregularly (no exposure group). The degree of donor limb edema and the differences of the peripheries of calf and thigh before and after the surgery (in 1, 2 and 4 weeks) were recorded and analyzed statistically. The patients' weight (P = 0.02) and the degree of their daily activity (P = 0.002) were the significant fa...

Research paper thumbnail of Unusual case of aortic coarctation complicated by mycotic pseudoaneurysm and bicuspid aortic valve endocarditis

Research in cardiovascular medicine, 2014

Coarctation complicated with mycotic pseudo-aneurysm is very rare. We are reporting a case of a 2... more Coarctation complicated with mycotic pseudo-aneurysm is very rare. We are reporting a case of a 26-year-old man suffered from this pathology. As the incidence of mycotic pseudo-aneurysm is very rare in patients with aortic coarctation, the choice of this pathology for a patient presenting with unexplained fever is the only way to reduce the mortality risk.

Research paper thumbnail of Haemostatic Role of TachoSil Surgical Patch in Cardiac Surgery

Journal of cardiovascular and thoracic research, 2014

Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic a... more Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria) is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique. Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon's judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients) or wait and see method (9 cases), were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/...

Research paper thumbnail of Amiodarone versus lidocaine for the prevention of reperfusion ventricular fibrillation: A randomized clinical trial

ARYA atherosclerosis, 2013

Reperfusion ventricular fibrillation after aortic cross clamp is one of the important complicatio... more Reperfusion ventricular fibrillation after aortic cross clamp is one of the important complications of open cardiac surgery and its prevention could reduce myocardial injuries. This study aimed to evaluate the efficacy of single dose of amiodarone or lidocaine by the way of pump circuit three minutes before aortic cross clamp release and compare the results with normal saline as placebo in a randomized double blinded controlled trial. One hundred fifty patients scheduled for first time elective coronary artery bypass graft surgery were randomly assigned to receive either single dose of amiodarone (150 mg), lidocaine (100 mg), or normal saline (5 ml) three minutes before aortic cross clamp release. The incidence of ventricular fibrillation and the need for reuse of drug were compared between these groups by chi-square, Student's t-test, Mann-Whitney test, and One-way ANOVA. SPSS software was used for statistical analysis. The incidence of ventricular fibrillation is higher in the...

Research paper thumbnail of Unusual clinical presentation of a giant left ventricle hydatid cyst

Journal of cardiovascular and thoracic research, 2013

A 39-year-old woman was hospitalized in our center due to chest and left shoulder pain. Having a ... more A 39-year-old woman was hospitalized in our center due to chest and left shoulder pain. Having a history of tamponade and tuberculosis, she was under treatment for the previous two months. Echocardiography, chest CT and MRI documented intramyocardial and pericardial hydatid cyst which was later confirmed by further pathological studies. Later, the cyst was removed surgically.

Research paper thumbnail of Diagnostic value of electrocardiography compared with echocardiography in measuring left ventricular mass index in major thalassemia patients over 10 years of age

The journal of Tehran Heart Center, 2013

Patients suffering from major beta thalassemia need frequent blood transfusions and, if not treat... more Patients suffering from major beta thalassemia need frequent blood transfusions and, if not treated well, would be at risk of heart dysfunction. This study was performed to determine the diagnostic value of electrocardiography versus echocardiography in measuring the left ventricular mass index in these patients. Between July 2010 and June 2011, 82 asymptomatic patients over 10 years of age with major thalassemia (42 men with a mean age of 17.65 ± 3.39 years and 40 women with a mean age of 16.9 ± 3.38 years) were enrolled in this study. For all the patients, standard electrocardiography (to measure R in aVL and S in V3 and calculate left ventricular mass index by electrocardiography) and echocardiography (to measure interventricular septum diameter in diastole, left ventricular posterior wall diameter in diastole, and left ventricular diameter in diastole in order to calculate left ventricular mass index by echocardiography) were performed, at least one week after transfusion. The c...

Research paper thumbnail of Constrictive pericarditis treated by surgery

Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2012

We reviewed the records of 45 patients (mean age, 46.6 ± 14.9 yr; range, 21-84 yr) with a diagnos... more We reviewed the records of 45 patients (mean age, 46.6 ± 14.9 yr; range, 21-84 yr) with a diagnosis of constrictive pericarditis who had undergone pericardiectomy from 1994 through 2006. Preoperatively, 2 of the patients (4.4%) were in New York Heart Association (NYHA) functional class I, 20 (44.4%) in class II, 22 (48.9%) in class III, and 1 (2.2%) in class IV. Pericardial calcification was detected in 20% of plain chest radiographs. Constrictive pericarditis was caused by tuberculosis in 22.2%, chronic renal failure in 8.9%, a history of sternotomy in 4.4%, and malignancy in 4.4%. The cause was idiopathic in 60% of the patients. Low-output state was the most common postoperative problem (22.2%). The mean follow-up period was 40 ± 18 months (range, 3-144 mo). Three months postoperatively, only 1 of 43 available patients (2.3%) was in NYHA class III, while the rest were in class I (36 patients; 83.7%) or II (6 patients; 14%). The overall mortality rate was 4.4%: 1 patient with tuber...

Research paper thumbnail of The Effects of Positive Airway Pressure Ventilation during Cardiopulmonary Bypass on Pulmonary Function Following Open Heart Surgery

Research in Cardiovascular Medicine, 2013

Background: Intrapulmonary shunt as a result of atelectasis following cardiac surgeries is an imp... more Background: Intrapulmonary shunt as a result of atelectasis following cardiac surgeries is an important and common postoperative complication that results into pulmonary dysfunction typically lasting more than a week following surgery. Different methods have been provided to prevent these complications. Objectives: In order to prevent postoperative pulmonary complications, investigation of the effectiveness of continuous positive airway pressure (CPAP) and intermittent mandatory ventilation (IMV) during cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG).

Research paper thumbnail of Accuracy of Doppler-Derived Indices in Predicting Pulmonary Vascular Resistance in Children With Pulmonary Hypertension Secondary to Congenital Heart Disease With Left-to-Right Shunting

Pediatric Cardiology, 2014

This study aimed to evaluate the accuracy of Doppler echocardiography-derived indices in children... more This study aimed to evaluate the accuracy of Doppler echocardiography-derived indices in children with pulmonary hypertension secondary to congenital heart disease with left-to-right shunting. Doppler-derived indices including the acceleration time corrected (AcTc), deceleration time corrected, deceleration index, peak velocity, heart-rate-corrected inflection time (InTc), and a new index (the acceleration slope [Acc = peak flow velocity/AcTc]) were measured from the pulmonary artery (PA) systolic flow curve before and after 100 % oxygen administration in the main, left, and right PAs of 33 children. The acquired data were compared between low and high pulmonary vascular resistance (PVR) groups and between responders and nonresponders to the vasoreactivity test. The AcTc values differed significantly between the low and high PVR groups before and after oxygen administration in the main (P = 0.032 and <0.001, respectively), right (P = 0.011 and <0.001, respectively), and left (P < 0.001 and <0.001, respectively) PAs. The AcTc cutoff point in the main PA was 3.44 before oxygen administration (81% sensitivity and 91% specificity). The InTc in the main PA and its changes differed significantly between the low and high PVR groups before and after oxygen administration and between the responders and nonresponders (P = 0.016, 0.046, and 0.021, respectively). The velocity changes of the PA in the main PA differed significantly between the responders and nonresponders to oxygen administration (P < 0.001). The Acc and its changes differed significantly between the low and high PVR groups after oxygen administration and between the responders and nonresponders to oxygen administration (P = 0.044 and 0.006, respectively). Doppler echocardiographic examination using PA systolic flow indices in addition to PA reactivity testing is a promising technique for assessing PVR in children with congenital heart disease.

Research paper thumbnail of The Impact of Sub-valvular Apparatus Preservation on Prosthetic Valve Dysfunction During Mitral Valve Replacement

Research in Cardiovascular Medicine, 2012

Sub-valvular apparatus preservation (SAP) during mitral valve replacement (MVR) is not a new conc... more Sub-valvular apparatus preservation (SAP) during mitral valve replacement (MVR) is not a new concept. Some surgeons prefer to excise the apparatus. The aim of this study was to reduce the risk of prosthetic valve dysfunction. This retrospective study included 151 patients with the mean age of 46 years who underwent MVR (Female/male = 93/58). In the group I consisting of 39 patients, MVR with chordae preservation was performed (Bi-leaflet preservation = 20; posterior leaflet preservation = 19). In the group II consisting of 112 patients, sub-valvular apparatus was resected completely during MVR. Preoperative patients' characteristics, including age, sex, functional status, left ventricular ejection fraction, and end-diastolic or end-systolic dimensions were statistically similar in both groups. Mean follow-up period was 60.3 ± 26 months. The improvement of functional status was seen in almost all survivors but was more obvious in the group I. In early follow-up, 56.4% of group I cases and 44.1% of group II patients were classified as New York Heart Association class I. These rates were 84.2% and 71.2% in mid-term follow-up, respectively (P < 0.001). Mortality rate was significantly lower in the group I (2.6%) compared to the group II (8.9%) (P = 0.03). There was a trend for higher frequency of postoperative atrial fibrillation in the group II compared to that in the group I (52.7% vs. 38.5%, P = 0.12).The incidence of prosthetic valve dysfunction (PVD) was 5.1% in the group I and 4.5% in the group II, but this difference was not statistically significant (P = 0.56). Preservation of mitral annulus and papillary muscle continuity may enhance post- MVR cardiac performance with low mortality and morbidity rates. The risk of PVD was not significantly higher than conventional MVR in our series.

Research paper thumbnail of A rare presentation of late right coronary artery spasm following aortic valve replacement

ARYA atherosclerosis, 2015

Coronary artery spasm (CAS) is defined as a reversible, sudden epicardial coronary artery stenosi... more Coronary artery spasm (CAS) is defined as a reversible, sudden epicardial coronary artery stenosis that causes vessel occlusion or near occlusion. In this article, we present a clinical case of CAS in a 48-year-old woman undergoing elective aortic valve replacement surgery for aortic stenosis. On the 3rd post-operative day, the patient suffered from chest pain and dyspnea. Emergent coronary angiography demonstrated a significant spasm of the ostium portion of the right coronary artery. This case shows that delayed coronary spasm should be considered as a cause of hemodynamic instability after valvular surgery.

Research paper thumbnail of Surgical outcomes of heart valves replacement: A study of tertiary specialied cardiac center

ARYA atherosclerosis, 2014

Heart valve disease is a significant and increasing global problem in the developing world. The a... more Heart valve disease is a significant and increasing global problem in the developing world. The aim of this study is to evaluate the incidence of postoperative complications and mortality in patients who underwent heart valve replacement. In this prospective study, 320 adult cases (186 females and 134 males, mean age of: 45.7 ± 15.0) with valvular heart diseases who underwent heart valve replacement at our center, from June 2011 to January 2012 were enrolled. All the required demographic, echocardiographic, and electrocardiogram data were studied. The incidence of intraoperative and early postoperative complications and mortality were evaluated. Among total, 96.3% of the cases underwent elective surgery. Mitral valve replacement surgery was occurred the most in 58.8% of the cases. In 11.3% of the cases, bioprosthetic valves and in 88.8% of the patients prosthetic valves were required. Early postoperative complications were occurred in 85 patients (26.6%), including: valve-related ev...

Research paper thumbnail of Prevention of edema after coronary artery bypass graft surgery by compression stockings

Research in cardiovascular medicine, 2014

Lower limb edema may occur after removal of the saphenous veins in coronary artery bypass graft (... more Lower limb edema may occur after removal of the saphenous veins in coronary artery bypass graft (CABG) surgery. Compression therapy is often used to prevent postoperative edema. The objective of this study was to evaluate the efficacy of medical compression stockings (TED) on the prevention of donor limbs edema and wound complications after CABG surgery. In this prospective cohort study, we enrolled 100 patients who underwent elective CABG surgery at Rajaie Cardiovascular Medical and Research Center. The patients were divided into two groups; group A who applied TED stockings regularly (exposure group) and group B who did not apply TED stockings at all or apply it irregularly (no exposure group). The degree of donor limb edema and the differences of the peripheries of calf and thigh before and after the surgery (in 1, 2 and 4 weeks) were recorded and analyzed statistically. The patients' weight (P = 0.02) and the degree of their daily activity (P = 0.002) were the significant fa...

Research paper thumbnail of Unusual case of aortic coarctation complicated by mycotic pseudoaneurysm and bicuspid aortic valve endocarditis

Research in cardiovascular medicine, 2014

Coarctation complicated with mycotic pseudo-aneurysm is very rare. We are reporting a case of a 2... more Coarctation complicated with mycotic pseudo-aneurysm is very rare. We are reporting a case of a 26-year-old man suffered from this pathology. As the incidence of mycotic pseudo-aneurysm is very rare in patients with aortic coarctation, the choice of this pathology for a patient presenting with unexplained fever is the only way to reduce the mortality risk.

Research paper thumbnail of Haemostatic Role of TachoSil Surgical Patch in Cardiac Surgery

Journal of cardiovascular and thoracic research, 2014

Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic a... more Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria) is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique. Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon's judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients) or wait and see method (9 cases), were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/...

Research paper thumbnail of Amiodarone versus lidocaine for the prevention of reperfusion ventricular fibrillation: A randomized clinical trial

ARYA atherosclerosis, 2013

Reperfusion ventricular fibrillation after aortic cross clamp is one of the important complicatio... more Reperfusion ventricular fibrillation after aortic cross clamp is one of the important complications of open cardiac surgery and its prevention could reduce myocardial injuries. This study aimed to evaluate the efficacy of single dose of amiodarone or lidocaine by the way of pump circuit three minutes before aortic cross clamp release and compare the results with normal saline as placebo in a randomized double blinded controlled trial. One hundred fifty patients scheduled for first time elective coronary artery bypass graft surgery were randomly assigned to receive either single dose of amiodarone (150 mg), lidocaine (100 mg), or normal saline (5 ml) three minutes before aortic cross clamp release. The incidence of ventricular fibrillation and the need for reuse of drug were compared between these groups by chi-square, Student's t-test, Mann-Whitney test, and One-way ANOVA. SPSS software was used for statistical analysis. The incidence of ventricular fibrillation is higher in the...

Research paper thumbnail of Unusual clinical presentation of a giant left ventricle hydatid cyst

Journal of cardiovascular and thoracic research, 2013

A 39-year-old woman was hospitalized in our center due to chest and left shoulder pain. Having a ... more A 39-year-old woman was hospitalized in our center due to chest and left shoulder pain. Having a history of tamponade and tuberculosis, she was under treatment for the previous two months. Echocardiography, chest CT and MRI documented intramyocardial and pericardial hydatid cyst which was later confirmed by further pathological studies. Later, the cyst was removed surgically.

Research paper thumbnail of Diagnostic value of electrocardiography compared with echocardiography in measuring left ventricular mass index in major thalassemia patients over 10 years of age

The journal of Tehran Heart Center, 2013

Patients suffering from major beta thalassemia need frequent blood transfusions and, if not treat... more Patients suffering from major beta thalassemia need frequent blood transfusions and, if not treated well, would be at risk of heart dysfunction. This study was performed to determine the diagnostic value of electrocardiography versus echocardiography in measuring the left ventricular mass index in these patients. Between July 2010 and June 2011, 82 asymptomatic patients over 10 years of age with major thalassemia (42 men with a mean age of 17.65 ± 3.39 years and 40 women with a mean age of 16.9 ± 3.38 years) were enrolled in this study. For all the patients, standard electrocardiography (to measure R in aVL and S in V3 and calculate left ventricular mass index by electrocardiography) and echocardiography (to measure interventricular septum diameter in diastole, left ventricular posterior wall diameter in diastole, and left ventricular diameter in diastole in order to calculate left ventricular mass index by echocardiography) were performed, at least one week after transfusion. The c...

Research paper thumbnail of Constrictive pericarditis treated by surgery

Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2012

We reviewed the records of 45 patients (mean age, 46.6 ± 14.9 yr; range, 21-84 yr) with a diagnos... more We reviewed the records of 45 patients (mean age, 46.6 ± 14.9 yr; range, 21-84 yr) with a diagnosis of constrictive pericarditis who had undergone pericardiectomy from 1994 through 2006. Preoperatively, 2 of the patients (4.4%) were in New York Heart Association (NYHA) functional class I, 20 (44.4%) in class II, 22 (48.9%) in class III, and 1 (2.2%) in class IV. Pericardial calcification was detected in 20% of plain chest radiographs. Constrictive pericarditis was caused by tuberculosis in 22.2%, chronic renal failure in 8.9%, a history of sternotomy in 4.4%, and malignancy in 4.4%. The cause was idiopathic in 60% of the patients. Low-output state was the most common postoperative problem (22.2%). The mean follow-up period was 40 ± 18 months (range, 3-144 mo). Three months postoperatively, only 1 of 43 available patients (2.3%) was in NYHA class III, while the rest were in class I (36 patients; 83.7%) or II (6 patients; 14%). The overall mortality rate was 4.4%: 1 patient with tuber...

Research paper thumbnail of The Effects of Positive Airway Pressure Ventilation during Cardiopulmonary Bypass on Pulmonary Function Following Open Heart Surgery

Research in Cardiovascular Medicine, 2013

Background: Intrapulmonary shunt as a result of atelectasis following cardiac surgeries is an imp... more Background: Intrapulmonary shunt as a result of atelectasis following cardiac surgeries is an important and common postoperative complication that results into pulmonary dysfunction typically lasting more than a week following surgery. Different methods have been provided to prevent these complications. Objectives: In order to prevent postoperative pulmonary complications, investigation of the effectiveness of continuous positive airway pressure (CPAP) and intermittent mandatory ventilation (IMV) during cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG).

Research paper thumbnail of Accuracy of Doppler-Derived Indices in Predicting Pulmonary Vascular Resistance in Children With Pulmonary Hypertension Secondary to Congenital Heart Disease With Left-to-Right Shunting

Pediatric Cardiology, 2014

This study aimed to evaluate the accuracy of Doppler echocardiography-derived indices in children... more This study aimed to evaluate the accuracy of Doppler echocardiography-derived indices in children with pulmonary hypertension secondary to congenital heart disease with left-to-right shunting. Doppler-derived indices including the acceleration time corrected (AcTc), deceleration time corrected, deceleration index, peak velocity, heart-rate-corrected inflection time (InTc), and a new index (the acceleration slope [Acc = peak flow velocity/AcTc]) were measured from the pulmonary artery (PA) systolic flow curve before and after 100 % oxygen administration in the main, left, and right PAs of 33 children. The acquired data were compared between low and high pulmonary vascular resistance (PVR) groups and between responders and nonresponders to the vasoreactivity test. The AcTc values differed significantly between the low and high PVR groups before and after oxygen administration in the main (P = 0.032 and <0.001, respectively), right (P = 0.011 and <0.001, respectively), and left (P < 0.001 and <0.001, respectively) PAs. The AcTc cutoff point in the main PA was 3.44 before oxygen administration (81% sensitivity and 91% specificity). The InTc in the main PA and its changes differed significantly between the low and high PVR groups before and after oxygen administration and between the responders and nonresponders (P = 0.016, 0.046, and 0.021, respectively). The velocity changes of the PA in the main PA differed significantly between the responders and nonresponders to oxygen administration (P < 0.001). The Acc and its changes differed significantly between the low and high PVR groups after oxygen administration and between the responders and nonresponders to oxygen administration (P = 0.044 and 0.006, respectively). Doppler echocardiographic examination using PA systolic flow indices in addition to PA reactivity testing is a promising technique for assessing PVR in children with congenital heart disease.

Research paper thumbnail of The Impact of Sub-valvular Apparatus Preservation on Prosthetic Valve Dysfunction During Mitral Valve Replacement

Research in Cardiovascular Medicine, 2012

Sub-valvular apparatus preservation (SAP) during mitral valve replacement (MVR) is not a new conc... more Sub-valvular apparatus preservation (SAP) during mitral valve replacement (MVR) is not a new concept. Some surgeons prefer to excise the apparatus. The aim of this study was to reduce the risk of prosthetic valve dysfunction. This retrospective study included 151 patients with the mean age of 46 years who underwent MVR (Female/male = 93/58). In the group I consisting of 39 patients, MVR with chordae preservation was performed (Bi-leaflet preservation = 20; posterior leaflet preservation = 19). In the group II consisting of 112 patients, sub-valvular apparatus was resected completely during MVR. Preoperative patients' characteristics, including age, sex, functional status, left ventricular ejection fraction, and end-diastolic or end-systolic dimensions were statistically similar in both groups. Mean follow-up period was 60.3 ± 26 months. The improvement of functional status was seen in almost all survivors but was more obvious in the group I. In early follow-up, 56.4% of group I cases and 44.1% of group II patients were classified as New York Heart Association class I. These rates were 84.2% and 71.2% in mid-term follow-up, respectively (P < 0.001). Mortality rate was significantly lower in the group I (2.6%) compared to the group II (8.9%) (P = 0.03). There was a trend for higher frequency of postoperative atrial fibrillation in the group II compared to that in the group I (52.7% vs. 38.5%, P = 0.12).The incidence of prosthetic valve dysfunction (PVD) was 5.1% in the group I and 4.5% in the group II, but this difference was not statistically significant (P = 0.56). Preservation of mitral annulus and papillary muscle continuity may enhance post- MVR cardiac performance with low mortality and morbidity rates. The risk of PVD was not significantly higher than conventional MVR in our series.