Long-term echocardiographic changes in left ventricular size and function following surgery for severe mitral regurgitation

Abstract

SummaryBackgroundChronic mitral regurgitation (MR) results in a state of chronic left ventricular (LV) volume overload, resulting in compensatory dilatation. Mitral valve (MV) surgery for regurgitation reduces LV preload but increases LV afterload. Few data are available documenting subsequent changes in LV size and function over time following MV surgery for severe regurgitation in unselected populations.Material/MethodsPre- and postoperative echocardiograms (n=454) acquired from 108 consecutive patients with chronic MR who underwent MV surgery were analyzed.ResultsLV diastolic diameter was 4 mm smaller on postoperative compared to preoperative exams, whereas LV fractional shortening (FS) was unchanged. Linear regression analysis showed no change in LV diastolic diameter over time postoperatively, whereas LV FS increased over time following surgery. Improvement in LV FS occurred at an average rate of 1.6% per year (95% CI, 0.2–2.9). Subgroups were small, but the same secular trends were generally noted in groups with or without coronary artery bypass graft surgery (CABGS) and in those with or without mitral leaflet disease.ConclusionsFollowing MV surgery for MR, LV diastolic diameter reduces by 2 mm at the time of surgery, but then remains stable over time. Improvement in LV function over time postoperatively was only seen in those without concomitant CABGS, possibly related to less baseline myocardial scarring in this group.

Incidence of new onset atrial fibrillation in patients with permanent pacemakers and the relation to the pacing mode

“…AV dissociation, that generally accompanies right ventricular pacing in a VVI mode, may also contribute to left atrial enlargement, fibrosis and occurrence of atrial fibrillation. The affect of AF on the mitral valve regurgitation conversely can have a significant left ventricular hemodynamic relevance and may require long-term valvular surgical correction [ 20 ].…”

Valor de la insuficiencia mitral previa a un primer infarto de miocardio, en el pronóstico clínico y la hemodinámica ventricular

“…Observó como el ORE disminuía en 13, aumentaba en 38, y aumentaba de forma muy marcada en los 19 restantes (49) . Este aumento del grado de insuficiencia mitral con el ejercicio es importante, ya que se ha visto que se asocia claramente con el desarrollo de edema agudo de pulmón (222) , y que además, el incremento en el ORE, con el ejercicio, mayor o igual a 13 mm 2 es un predictor independiente de muerte cardiaca (50) .…”