Examination of Anterior Leaflet Pseudoprolapse Causing Severe Mitral Regurgitation and Its Ideal Surgical Procedure

Authors

  • Chiharu Tanaka Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
  • Kazumi Akasaka Medical Laboratory and Blood Center, Asahikawa Medical University Hospital, Asahikawa, Japan
  • Ryohei Ushioda Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
  • Tomoki Nakatsu Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
  • Naohiro Wakabayashi Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
  • Hayato Ise Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
  • Hiroto Kitahara Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
  • Sentaro Nakanishi Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
  • Natsuya Ishikawa Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
  • Hiroyuki Kamiya Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan

DOI:

https://doi.org/10.1532/hsf.2895

Keywords:

Pseudoprolapse, Annuloplasty, Mitral valve, Mitral repair, Atrial functional mitral regurgitation

Abstract

Background: The aim of this study is to evaluate severe mitral regurgitation caused by so called atrial leaflet “pseudoprolapse” and verify the effect of simple
annular stabilization.

Methods: One-hundred-twenty-two patients underwent surgery for severe mitral regurgitation at our institute between January 2015 to July 2018. Of those, 32 cases diagnosed as anterior leaflet prolapse that underwent mitral repair were analyzed. Ten cases with pseudoprolapse, which is defined as anterior leaflet prolapse without dropping into the left atrium beyond the annular line causing eccentric regurgitation flow directed to the posterior atrium, were classified as the Pseudoprolapse Group. The other 22 cases had obvious anterior leaflet prolapse dropping into the left atrium; these cases were classified as the True Prolapse Group. We compared clinical findings between the 2 groups and reviewed pseudoprolapse cases.

Results: Patients in the Pseudoprolapse Group had lower ejection fraction and lower regurgitation volume than those in the True Prolapse Group. A2 lesion as main inflow of regurgitation was more included in the
Pseudoprolapse Group. All but one patient in the
Pseudoprolapse Group received only simple annuloplasty, and all patients in the True Prolapse Group received leaflet repair and annuloplasty. In both groups, mid-term regurgitation grade and the reoperation rate were satisfactory. In the Pseudoprolapse Group, 6 cases were clarified as atrial functional mitral regurgitation, and 4 cases were considered to have focal posterior leaflet tethering.

Conclusions: Pseudoprolapse cases could be characterized by low ejection fraction, low regurgitation volume, and A2 prolapse. For most cases with pseudoprolapse, simple annuloplasty may be enough, however further study
is needed.

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Published

2020-04-13

How to Cite

Tanaka, C., Akasaka, K., Ushioda, R., Nakatsu, T., Wakabayashi, N., Ise, H., Kitahara, H., Nakanishi, S., Ishikawa, N., & Kamiya, H. (2020). Examination of Anterior Leaflet Pseudoprolapse Causing Severe Mitral Regurgitation and Its Ideal Surgical Procedure. The Heart Surgery Forum, 23(2), E205-E211. https://doi.org/10.1532/hsf.2895

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