Clinical evaluation of functional mitral stenosis after mitral valve repair for degenerative disease: Potential affect on surgical strategy

Abstract

Annuloplasty using a complete ring may be associated with a higher mitral valve gradient at rest and at peak exercise in certain patients. These patients may also have worse quality of life. In view of these findings, we recommend careful consideration of annuloplasty type and size at the time of mitral repair of organic disease.

Mitral valve gradient after valve repair of degenerative regurgitation with restrictive annuloplasty

“…3 The effects of such repair have not been well studied, however, and only a few reports have been published to date. 4,5 We studied our experience in this setting to better understand the effect of mitral valve repair as it relates to long-term valve gradient.…”

Management of Incomplete Initial Repair in the Treatment of Degenerative Mitral Insufficiency

“…However, combined repair techniques increase the mTMG, especially when the edge-toedge technique is used. 12,13) In this study, despite efforts to maintain as large a remnant orifice area as possible, an elevated mTMG was detected in six patients who had undergone edge-to-edge suturing. Considering the fact that removal of the suture would again lead to significant regurgitation, replacement of the mitral valve was performed.…”

Pulmonary arterial pressure detects functional mitral stenosis after annuloplasty for primary mitral regurgitation: An exercise stress echocardiographic study

“…In previous studies, the functional mitral stenosis has been defined as a mean transmitral pressure gradient of >5 mm Hg or a mitral valve area (MVA) of <1.5 cm 2 in patients with a functional MR secondary to either ischemic or idiopathic cardiomyopathy . In addition, a higher mitral valve gradient at rest and at peak exercise as an indicative of functional mitral stenosis has been found to be influenced by the type of annuloplasty in patients with degenerative MR …”

“…5 In previous studies, the functional mitral stenosis has been defined as a mean transmitral pressure gradient of >5 mm Hg or a mitral valve area (MVA) of <1.5 cm 2 in patients with a functional MR secondary to either ischemic or idiopathic cardiomyopathy. [6][7][8][9][10][11][12][13][14] In addition, a higher mitral valve gradient at rest and at peak exercise as an indicative of functional mitral stenosis has been found to be influenced by the type of annuloplasty in patients with degenerative MR. 15,16 In this study, we sought to determine the prevalence of functional mitral stenosis in patients undergoing RMA with complete ring for myxomatous MR. In addition, we decided to evaluate the patients' functional capacity and hemodynamic outcomes using the implementation of treadmill exercise test associated with an echocardiographic evaluation of mitral valve hemodynamics during exercise test.…”