Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement
AbstractBackground: Mitral valve regurgitation leads to deterioration of left ventricular functions if not treated early. We aimed to study the effect of mitral valve replacement on normalization of ejection fraction, remodeling of left ventricular dimensions, and left atrial reduction in patients with chronic mitral regurgitation.
Methods: Between December 2012 and August 2014,
45 patients with chronic mitral regurgitation underwent isolated mitral valve replacement. None of the patients had any other severe valvular or concomitant disease or severe coronary heart disease. The patients were evaluated by echocardiography (preoperative, 1-week, and 1-year postoperative). The results were statistically analyzed by paired t test.
Results: Forty-five patients who underwent mitral valve replacement in our hospital were included in the study. The group comprised 20 men and 25 women; the mean age was 31.8 ± 6.76 years. The mean left ventricular ejection fraction was 61.09 ± 7.6 and decreased significantly to 59.04 ± 6.65 and 59.67 ± 6.56, 1-week and 1-year postoperative follow up, respectively. The left atrium showed significant reduction in size (4 ± 0.54 cm) at 1-year postoperative follow up, from (4.51 ± 0.57 cm) one-week postoperative, and from (5.55 ± 0.88 cm) preoperatively. The mean left ventricular end systolic diameter significantly decreased from 4.06 ± 0.65 cm preoperatively to 3.4 ± 0.4 cm, 1-week postoperative (P = .01), and also decreased significantly to 3.45 ± 0.51 cm at 1-year follow up postoperatively, but was higher than that at 1-week follow up. Also, the mean left ventricular end diastolic diameter decreased significantly during periods of follow up (P < .001).
Conclusion: Reversal of left ventricular functions and reduction of left-sided chamber dimensions are possible if early mitral valve replacement is considered in chronic mitral regurgitation before worsening of the condition.
Apostolakis E, Shuhaiber JH. 2008. The surgical management of giant left atrium. Eur J Cardiothorac Surg 33:182-90.
Badhwar V, Rovin JD, Davenport G, et al. 2006. Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery. Ann Thorac Surg 82:1758-64.
Bonchek LI, Olinger GN, Siegel R, Tresch DD, Keelan MH Jr. 1984. Left ventricular performance after mitral reconstruction for mitral regurgitation. J Thorac Cardiovasc Surg 88:122-7.
Choo S, Park N, Lee S, et al. 2004. Excellent results of fibrillation surgery in the presence of giant left atrium and mitral valve disease. Eur J Cardiothorac Surg 26:336-41.
Corin WJ, Sutsch G, Murakami T, Krogmann ON, Turina M, Hess OM. 1995. Left ventricular function in chronic mitral regurgitation: preoperative and postoperative comparison. J Am Coll Cardiol 25:113-21.
David TE, Burns RJ, Bacchus CM, Druck MN. 1984. Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae. J Thorac Cardiovasc Surg 88:718-25.
Di Eusanio G, Gregorini R, Mazzola A, et al. 1998. Giant left atrium and mitral valve replacement: risk factor analysis. Eur J Cardiothorac Surg 2:151-9.
Enriquez-Sarano M, Tajik AJ, Schaff HV, et al. 1994. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J Am Coll Cardiol 24:1536-43.
Flemming MA, Oral H, Rothman ED, Briesmiester K, Petrusha JA, Starling MR. 2000. Echocardiographic markers for mitral valve surgery to preserve left ventricular performance in mitral regurgitation. Am Heart J 140:476-82.
Garcia-Villarreal OA, RodrÄ±guez H, Trevino A, Gouveia AB, Arguero R. 2001. Left atrial reduction and mitral valve surgery: the ‘‘function anatomic unit’’ concept. Ann Thorac Surg 71:1044-5.
Hagihara H, Kitamura S, Kawachi K, et al. 1995. Left atrial plication combined with mitral valve surgery in patient with a giant left atrium. Surg Today 25:338-42.
Kutay V, Kirali K, Ekim H, Yakut C. 2005. Effect of giant left atrium on thromboembolism after mitral valve replacement. Asian Cardiovasc Thorac Ann 13:107-11.
Le Tourneau T, de Groote P, Millaire A, et al. 2000. Effect of mitral valve surgery on exercise capacity, ventricular ejection fraction and neurohormonal activation in patients with severe mitral regurgitation. J Am Coll Cardiol 36:2263-9.
Matsumura T, Ohtaki E, Tanaka K, et al. 2003. Echocardiographic prediction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair. J Am Coll Cardiol 42:458-63.
Pande S, Agarwal SK, Mohanty S, Bansal A. 2013. Effect of mitral valve replacement on reduction of left atrial size. Asian Cardiovasc Thorac Ann 21:288.
Rastelli GC, Tsakiris AG, Frye RL, Kirklin JW. 1967. Exercise tolerance and hemodynamic studies after replacement of canine mitral valve with and without preservation of chordae tendineae. Circulation 35(4 Suppl):I34-41.
Scherer M, Dzemali O, Aybek T, Wimmer-Greinecker G, Moritz A. 2003. Impact of left atrial size reduction on chronic atrial fibrillation in mitral valve surgery. J Heart Valve Dis 12:469-74.
Scherer M, Therapidis P, Miskovic A, Moritz A. 2006. Left atrial size reduction improves the sinus rhythm conversion rate after radiofrequency ablation for continuous atrial fibrillation in patients undergoing concomitant cardiac surgery. Thorac Cardiovasc Surg 54:34-8.
Starling MR, Kirsh MM, Montgomery DG, Gross MD. 1993. Impaired left ventricular contractile function in patients with long-term mitral regurgitation and normal ejection fraction. J Am Coll Cardiol 22:239-50.
Starling MR. 1995. Effects of valve surgery on left ventricular contractile function in patients with long-term mitral regurgitation. Circulation 92:811-8.
Suri RM, Schaff HV, Dearani JA, et al. 2009. Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse. J Thorac Cardiovasc Surg 137:1071-6.
Winlaw DS, Farnsworth AE, Macdonald PS, Mundy JA, Spratt PM. 1998. Left atrial reduction: the forgotten Batista. Lancet 351:879-80.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).