Low‐Dose Dobutamine Stress Echocardiography to Predict Reversibility of Mitral Regurgitation with CABG

Abstract

The optimal management of moderate (grade 2-3+) ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) remains controversial. While CABG alone can reverse regurgitation in some patients with moderate MR, adjunctive mitral repair may be necessary in others. We performed low-dose dobutamine stress echocardiography (DSE) in 60 patients with moderate MR who were about to undergo CABG. Group I, 25 patients who demonstrated reduction in MR during DSE, had CABG alone. Group II, 35 patients in whom MR was unchanged during DSE, had mitral valve repair as well as CABG. MR was reduced postoperatively in both groups (P < 0.0001). Postoperative ejection fraction in Group I (12.2%) improved more than that in Group II (9.3%) (P < 0.01). We conclude that CABG alone may be sufficient to correct moderate MR when MR is reduced during DSE.

Three‐Dimensional Transesophageal Echocardiographic Study of Aortic‐Mitral Valve Coupling after Coronary Artery Bypass Grafting

“…The improvement in the LVEF increased the MV closing force. We consider that an improved LVEF plays an important role in reducing MR; this is consistent with the conclusion reached by Mustonen et al 12 and Roshanali et al 24 In the present study, patients with severe MR did not undergo a mitral procedure at the time of CABG because the risks of morbidity and mortality may be higher when combining CABG with MV repair than when performing CABG alone. Furthermore, the structure of the MV was satisfactory in these patients, so the severe MR was left untreated.…”

“…We consider that an improved LVEF plays an important role in reducing MR; this is consistent with the conclusion reached by Mustonen et al . and Roshanali et al …”

Mitral Valve Regurgitation: Paradoxical Behavior of Dobutamine Stress Cardiac Magnetic Resonance Imaging

“…6 In this case, likely due to improving ventricular geometry in the setting of restricted subvalvular apparatus, the MR disappeared due to relaxation of the restricted chordae tendineae concurrent with decreasing LVEDD and left ventricular end-systolic diameter (LVESD). Nevertheless, in some cases with significant mitral apparatus preservation, MR can potentially improve.…”

Recurrent Mitral Regurgitation Late after Annuloplasty for Ischemic Mitral Regurgitation

“…This understanding of the mechanism behind functional ischemic MR has led to questions about the validity of surgical annuloplasties which do not address global changes in the ventricle. 11 Revascularization of ischemic areas alone improves regional wall motion and indeed corrects MR definitively in most cases with trace to even moderate MR. 22 Whatever the surgical method, induction of reverse left ventricular remodeling minimizes the incidence of MR. 23,24 Our results clearly show that indeed, how well left ventricular geometry and function are maintained after annuloplasty plays a key role in determining whether or not recurrent MR develops.…”