Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement


  • Montaser Elsawy Abd elaziz Cardiothoracic Surgery Department, Menoufia University, Almenoufia
  • Islam Moheb Ibrahim Cardiothoracic Surgery Department, Menoufia University, Almenoufia



Background: 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.

Author Biographies

Montaser Elsawy Abd elaziz, Cardiothoracic Surgery Department, Menoufia University, Almenoufia

Cardiothoracic surgery department,Faculty of medicine, Menoufia University

Islam Moheb Ibrahim, Cardiothoracic Surgery Department, Menoufia University, Almenoufia

Cardiothoracic surgery department, Faculty of medicine, Menoufia University


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, Rodrıguez 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

Abd elaziz, M. E., & Ibrahim, I. M. (2016). Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement. The Heart Surgery Forum, 19(4), E160-E164.