Sami S. Kabbani MD, Donald N. Ross FRCS, Hisham Jamil MD, Abdo Hammoud MD, Fawzi Nabhani MD, Ryad Hariri MD, Loay S. Kabbani MD

To find a satisfactory mitral valve substitute for rheumatic patients in developing countries, we returned to an original concept first reported by one of the authors (D. N. R.) in 1967. Twenty-two patients (mean age 40.3 years; range: 28 to 57 years) with unrepairable rheumatic disease were subjected to excision of their mitral valves and replacement with a composite graft made of the inverted pulmonary autograft, incorporated in a Dacron conduit, and attached proximally to a pericardial collar. The autograft conduit was positioned in the left atrium, while the pericardial collar was attached to the adjacent atrial wall, covering all prosthetic material. One patient developed a fatal cerebrovascular accident, probably due to an inverted pericardial collar. In a second patient the autograft had to be replaced because of bacterial endocarditis contracted in the operating room. Echocardiography confirmed excellent function of the remaining 20 autografts up to 16 months postoperatively.