Functional Mitral Regurgitation: Imaging Insights, Clinical Outcomes and Surgical Principles

Watanabe, Nozomi; Maltais, Simon; Nishino, Shun; O'Donoghue, Tara A.; Hung, Judy

doi:10.1016/j.pcad.2017.11.006

Cited by 13 publications

(13 citation statements)

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“…The success rates of saddle shape annuloplasty of the MV have been quantified using various imaging modalities, with optimal valve performance shown to be dependent on band shape [22]. These findings led to the introduction of a new generation of saddle-shaped annuloplasty rings, which were found to be superior to flat rings in maintaining more physiologic patterns of annular and leaflet geometry [14]. We hypothesized that, despite the negative influence of undersized annuloplasty rings on leaflet cooptation, undersized saddleshaped annuloplasty rings for IMR would have a substantial beneficial influence on leaflet cooptation.…”

Section: Discussionmentioning

confidence: 99%

“…Classification of this physiopathological triad of severe MR has enhanced the ability to choose the optimal surgical repair technique for any MV pathology [12,13]. This classification included clear descriptions of the etiology of MR as degenerative or ischemic; of valve damage as cord rupture or perforation; and of valve dysfunction [14]. Methods of MV reconstructive surgery specific to these three classes of valve dysfunction have been developed, including for specific types of lesions and pathologies [15].…”

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confidence: 99%

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Partial Annuloplasty Rings in the Repair of Functional Ischemic Mitral Regurgitation

Kunwar

Imran

Khan

et al. 2020

Cureus

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Background Acute myocardial infarction (MI) is the leading cause of worldwide cardiac morbidities and mortalities. Mitral regurgitation (MR) is a common complication of MI. The severity of ischemic MR (IMR) can range widely, both clinically and hemodynamically. Mitral valve (MV) repair by lifting annuloplasty is a surgical procedure used to correct the pathology of IMR. The immediate outcomes of this technique have not yet been determined. The present study, therefore, evaluated the immediate results of MV annuloplasty performed to complement MV repair in patients with IMR. Methodology All adult patients with IMR who underwent lifting posterior mitral annuloplasty (LPMA) plus concomitant coronary artery bypass grafting (CABG) were included. Immediate outcomes were evaluated by transesophageal color Doppler echocardiography. The frequency of successful outcomes was compared in patients with different baseline characteristics. Results Posterior mitral annuloplasty was successful in 93.1% of patients, including in 92.8% of men and 94.1% of women. The percentages of successful immediate outcomes differed significantly in patients with and without diabetes and hypertension, and in patients with two-and threevessel disease. Conclusion LPMA resulted in a high percentage of successful immediate outcomes in patients with IMR. Further studies should compare rates of immediate, intermediate, and late outcomes of this technique.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Partial Annuloplasty Rings in the Repair of Functional Ischemic Mitral Regurgitation

Kunwar

Imran

Khan

et al. 2020

Cureus

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“…The basic mechanism of functional MR is subvalvular tethering by LV dilatation. When the LV dilates, the PMs are displaced outward, and the displaced PMs tether the MV leaflets, resulting in impaired MV leaflet mobility and coaptation (25,31). In this case, the LV and PMs tether the MV leaflets.…”

Section: H700mentioning

confidence: 99%

“…Characteristics of LV remodeling and its relation to MVC tissue lengths in Barlow-type MV prolapse could be of great importance; however, it was not clarified by the present study. Myocardial and MV leaflet tissue elongation have been documented in variable situations, such as MV prolapse, hypertrophic cardiomyopathy, aortic valve disease, and others (1,5,10,18,21,31), with a potential of genetic link between these tissue elongations. However, genetic investigation was not fully performed and familial DCM was not proved in this study.…”

Section: H700mentioning

confidence: 99%

Potential mechanism of left ventricular spherical remodeling: association of mitral valve complex-myocardium longitudinal tissue remodeling mismatch

Nagata

Iwataki

Nabeshima

et al. 2020

American Journal of Physiology-Heart and Circulatory Physiology

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Since mitral valve (MV) complex (MVC) longitudinally bridges left ventricular (LV) base-end and its middle, insufficient MVC longitudinal tissue length (TL) elongation relative to whole LV myocardial longitudinal TL elongation could limit LV-base-longitudinal-TL elongation, leading to predominant LV-base-transverse-TL elongation, constituting LV spherical remodeling. In 30 patients with dilated cardiomyopathy (DCM), 30 with aortic regurgitation (AR), and 30 controls, LV sphericity, LV-apex- or base- transverse- and longitudinal-TL, MVC-longitudinal-TL and whole-LV-longitudinal-TL were measured by 3D echocardiography. Ratio of each measure vs. mean normal value (i.e., LV-apex-transverse-TL ratio) was considered to express the directional and regional tissue elongation. [LV-base-longitudinal-TL ratio/global-LV-TL ratio] and [MVC-longitudinal-TL ratio/whole-LV-longitudinal-TL ratio] were obtained as the degree of LV-base-longitudinal-TL or MVC-longitudinal-TL elongation relative to the whole LV elongation. LV-apex-transverse-, LV-apex-longitudinal- and LV-base-transverse-TL ratios were significantly increased (1.27 to 1.42, p<0.01) in both DCM and AR, while the LV-base-longitudinal-TL ratio was not increased in DCM (1.04±0.19, n.s.) and only modestly increased in AR (1.12±0.21, p<0.01). Whole-LV-longitudinal-TL ratio was significantly increased in both DCM and AR (1.22±0.18 and 1.20±0.16, p<0.01), while MVC-longitudinal-TL ratio was not or only modestly increased in both groups (1.07±0.15, n.s. and 1.12±0.17, p=0.02, respectively). Multivariable analysis revealed that LV sphericity was independently related to a reduced [LV-base-longitudinal-TL ratio/global-LV-TL ratio] (standard β=-0.42, p<0.01), which was further related to a reduced [MVC-longitudinal-TL ratio/whole-LV-longitudinal-TL ratio] (standard β=0.72, p<0.01). These are consistent with the hypothesis that relatively less MVC-longitudinal-TL elongation in the process of primary LV myocardial tissue elongation may limit LV-base-longitudinal-TL elongation, contributing to LV spherical remodeling.

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“…Functional mitral regurgitation (FMR) is defined as MR associated with poor remodeling and dysfunction of the left ventricle or mitral annulus in the presence of a structurally normal mitral leaflet. The literature shows that FMR predicts a poor prognosis and is frequently associated with increased morbidity and mortality [1,5,6] . Approximately 35% to 50% of patients with heart failure develop FMR, and these patients have a poor prognosis [5–8] .…”

Section: Introductionmentioning

confidence: 99%

Functional mitral regurgitation combined with increased early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio is associated with a poor prognosis in patients with shock

Zhou

Zou

Yin

et al. 2021

Chinese Medical Journal

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Background: Functional mitral regurgitation (FMR) is common in critically ill patients and may cause left atrial (LA) pressure elevation. This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock. Methods: We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017. The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio (E/e’) ≥ 4 within 6 h of shock on the prognosis of patients were evaluated. Finally, the synergistic effect of FMR and E/e’ were assessed by combination, grouping, and trend analyses. Results: Forty-four patients (33.8%) had FMR, and 15 patients (11.5%) had E/e’ elevation. A multivariate analysis revealed FMR and E/e’ as independent correlated factors for 28-day mortality ( P = 0.043 and 0.028, respectively). The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR ( χ 2 = 7.672, P = 0.006) and between the E/e’ ≥ 14 and E/e’ < 14 groups ( χ 2 = 19.351, P < 0.010). Twenty-eight-day mortality was significantly different among the four groups ( χ 2 = 30.141, P < 0.010). The risk of 28-day mortality was significantly higher in group 4 (E/e’ ≥ 14 with FMR) compared with groups 1 (E/e’ < 14 without FMR) and 2 (E/e’ < 14 with FMR) ( P = 0.001 and 0.046, respectively). Conclusions: Patients with shock can be identified by the presence of FMR. FMR and E/e’ are independent risk factors for a poor prognosis in these patients, and prognosis is worst when FMR and E/e’ ≥ 14 are present. It may be possible to improve prognosis by reducing LA pressure and E/e’. Trial Registration: ClinicalTrials.gov, NCT03082326.

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Functional Mitral Regurgitation: Imaging Insights, Clinical Outcomes and Surgical Principles

Cited by 13 publications

References 50 publications

Partial Annuloplasty Rings in the Repair of Functional Ischemic Mitral Regurgitation

Partial Annuloplasty Rings in the Repair of Functional Ischemic Mitral Regurgitation

Potential mechanism of left ventricular spherical remodeling: association of mitral valve complex-myocardium longitudinal tissue remodeling mismatch

Functional mitral regurgitation combined with increased early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio is associated with a poor prognosis in patients with shock

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