Preliminary observations on haemodynamics during physiological stress conditions following ‘double-orifice’ mitral valve repair

Abstract

This study indicates that though effective mitral valve competence is achieved in the majority of operated patients, DO repair may induce impaired diastolic mitral dynamism in some cases, particularly during exercise conditions. Further investigations are required to thoroughly elucidate the overall mechanics of a DO valve, especially at strenuous cardiocirculatory states.

Left atrial remodelling early after mitral valve repair for degenerative mitral regurgitation

“…Several studies showed that mean and peak transmitral valve gradients are slightly higher during exercise in patients with degenerative MR who have undergone edge-to-edge technique with or without annuloplasty ring 26 27. A slightly lower postoperative reduction in LAVi and a slightly higher postoperative transmitral mean pressure gradient were observed in our study in these patients than in patients with other types of repair.…”

Rest and Dobutamine stress echocardiography in the evaluation of mid-term results of mitral valve repair in Barlow's disease

“…LVOTO is caused by systolic anterior motion of the anterior mitral leaflet and may occur in presence of excess tissue of the mitral leaflets and inadequate ring sizing, resulting in a "too small ring for a too large anterior leaflet" [2]. Impaired diastolic transmitral flow, with significant increase in transvalvular pressure gradient and in sPAP at peak exercise, have recently been reported in patients treated by the "double-orifice" technique [25]. Impaired diastolic annular dynamics and hampered exercise-related increase in left ventricular ejection fraction can occur when a rigid ring is employed [32,33].…”

“…TTE and TEE are the most usual and useful tools to evaluate intra- and post-operative results [5-17], while exercise TTE is usually employed to evaluate valvular dynamics and function under stress conditions [25,26]. …”

“…Jebara and Coll found an incidence of LVOTO very low (2.4%) when the "sliding technique and prosthetic ring annuloplasty", was used [15]. Transient LVOTO has been observed during exercise test, associated with mitral systolic anterior motion and significant intraventricular gradient, in patients with repaired mitral valve [25]. The absence of LVOTO in basal condition in our series supports the need at surgery of reducing the height of the posterior leaflet, particularly in patients with extensive myxomatous degeneration of both leaflets.…”

“…Debate, however, persists over the long-term stability of correction of MR due to extensive myxomatous degeneration of both leaflets [18-24] and over the hemodynamics of the repaired valve under stress conditions. Exercise echocardiography, considered a physiological stress test, was used to evaluate the hemodynamic changes and to unmask valve dysfunction under exercise conditions [25,26]. However, informations derived from this test are limited because of the difficulty in obtaining adequate Doppler signals due to respiratory-related artefacts or to increased chest wall motion, or because patients are unable or unwilling to perform an exercise protocol.…”