Clinical Outcome of Mitral Regurgitation Due to Flail Leaflet

Abstract

When treated medically, mitral regurgitation due to flail leaflet is associated with excess mortality and high morbidity. Surgery is almost unavoidable within 10 years after the diagnosis and appears to be associated with an improved prognosis; this finding suggests that surgery should be considered early in the course of the disease.

Diagnóstico pela ecocardiografia transesofágica e evolução de 35 pacientes portadores de flail mitral valve

“…Posteriormente, o ecocardiograma bidimensional acrescentou muito ao diagnóstico, permitindo a visualização da movimentação anô-mala do folheto dentro do AE e conseqüente falha de coaptação da valva mitral 2 . Contudo, devido à proximidade do esôfago ao AE, o ecocardiograma transesofágico (ETE) permite uma melhor exploração da cavidade atrial e, portanto, esta metodologia mostra-se mais sensível e específica no diagnóstico da ruptura da valva mitral do que o ecocardiograma transtorácico (ETT) 2,3 , permitindo o diagnóstico acurado do flail e de seu mecanismo subjacente. Na imensa maioria dos casos, este se dá por ruptura de cordoalha e, apenas excepcionalmente, por cordoalhas alongadas e redundantes, porém sem ruptura 3 .…”

“…A correção cirúrgica pode aliviar os sintomas, porém, quando é realizada em pacientes sintomáticos já com função sistólica ventricular comprometida, estes evoluem com ICC no pós-operatório e apresentam prognóstico ruim 3 . Assim, a correção cirúrgica deve ser realizada precocemente, seguramente antes de se instalar a disfunção do VE.…”

“…Contudo, a morbimortalidade a longo prazo é elevada. Em importante estudo realizado na Clínica Mayo, em 229 pacientes com diagnóstico de flail mitral valve, a taxa anual de mortalidade dos pacientes tratados clinicamente foi superior a dos pacientes submetidos a cirurgia 3 . Neste estudo, após 10 anos de acompanhamento, 63% dos pacientes encontravam-se em ICC, 30% apresentavam fibrilação atrial e 90% tinham sido submetidos a cirurgia valvar ou evoluído para óbito, demonstrando assim a alta morbimortalidade desta doença a longo prazo.…”

Prognostic Value of Exercise Tolerance Testing in Asymptomatic Chronic Nonischemic Mitral Regurgitation

“…Follow-up clinical status was evaluated by a combination of personal or telephone interview and review of medical and vital records. All patients were followed until death or to currently defined predictors of significantly compromised prognosis commonly employed as bases for mitral valve surgery, i.e., new onset of heart failure symptoms (Functional Class≥2) (15), LV ejection fraction rest <10% higher than the lower limit of normal for the testing modality (<60% by echo [16]), new onset atrial fibrillation (17), or echocardiographic LVIDs≥45mm (18), an accepted criterion when the study was performed, and LVIDs>40mm, a more recently suggested criterion for surgery (19) that was not employed at the time this study was undertaken. Echocardiographic effective regurgitant orifice area, recently reported to have significant prognostic impact (20), was not measured in our laboratory during this study.…”

Do Vasodilators Interfere with Left Ventricular Remodeling in Chronic Mitral Regurgitation?

“…Variations in the systolic diameter between 45 and 55 mm 2,3 , in the diastolic diameter above 70 mm 3 , or correlations between cavitary increase and body surface 4 are not satisfactory. However, signals of reduction in left ventricular function draw attention to the advanced character of the disease [1][2][3][4] .The type of drug, its dosage, and the period of time during which it is used influence the vasodilator effect on mitral regurgitation. Greenberg et al 5 , using hydralazine, and Schön et al 6 , using quinapril, reported a reduction in left ventricular diameter and improvement of symptoms.…”